FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE:TON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES TYEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 2324 Navy Drive City$toCkton Lot Size PM Owner's Name PDM Strocal Address 9859 Horn Road, Sacramento Phone Contractor Beyl i k Drilling, i nmddres5 3429 Longview Dr. License No. 306291 Phone 9 1 6).4$5_-M 2 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK n/a SEWER LINES 250 DISPOSAL FLD. n/a PROP. LINE _LE FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Orr ❑ Industrial O Open Bottom ❑ Manteca Dia. of Well Excavation — F Dia. of Well Casing ❑ Domestic/Private LA Gravel Pack ❑ Tracy Type of Casing PVCSpecifications rl Public 1=1 Other Cl Delta Depth of Grout Seal 101 Type of Grout Neat Cement IxxI Irric�atio�L 30_Approx• Depth I I Eastern Surface Seal Installed by Contractor'_ _ FtepanUWoI01rone ❑ Type of Pump H.P, State Work Done_ Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION i 1 REPAIRIADDITION i I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartment PKG. TREATMENT PLT. ❑ Method ojq r Distance to nearest: Well Foundation Property Line 441 LEACHING LINE ❑ No. & Length of lines Total length/size M4 0 FILTER BED ❑ Distance to nearest: Well Foundation Property Line MAY SEEPAGE PITS l I Depth Size Number_ ENVI ENTAL H 4 l l SUMPS ❑ Distance to nearest: Well Foundation Property tine DISPOSAL PONDS ❑ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin Local Health District. Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of California." The applicant must call for all required inspections. Complete drawing on reverse side. Signed X__A _ Title: ,11"O,ject Manager Data: May 15, :1989 David S. Bardsley FOR DEPARTMENT USE ONLY I Application Accepted by Date Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'No. ..EH 13-24(REV.L/K51 - EH 14-2a f.�