SU0013462 - Laserfiche WebLink

Home Browse Search

' r SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 KA JOB 20-3574-01 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) DSS-070-zq Application is hereby made to San Joaquin County 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 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. APN .#055-070-14 GRAIN STORAGE TANKS � 0-4'5wi 'GET�Ti�Y12',;WEST OF I-5 City Lot Size/Acreage Job Address foiCJ+�` =77f4�T SG�w I Owner's Name KLEIN BROS. LTD. Address 1305 W.FREXONT ST. ,STOCKTON Phone ! _ - Spec Address.2825 E. Myrtle Street License No. 512268 Phone 948-134 Contractor p _ TYPE OF WELL/PUMP: NEW WELL D WELL REPLACEMENT I.'• DESTRUCTION--C+t— yU6 -m PUMP INSTALLATION D SYSTEM REPAIR D OTHER [X DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROF -title 3,Test Bor ngs FOUNDATION AGRICULTURE WELL OTHER WELL PFF,o&i,+MP& 20'-40' De p Dia INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS No GW Industrial Q Open Bottom ❑ Manteca Dia. of Well Excavation Bis•-of we" -99 MW- anticipated Ci Domestic/Private D Gravel Pack 0 Tracy Type of Casing__ Specil'ee If GW I•! Public f.' Other I-1 Delta Depth of Grout Seal {'YPeof-6 cN A rox. Depth 1 i Eastern Surface Sedl Installed by encoulltered,will e\ i IrriOatron pp ' State Work Done , backfill with Repair Work Done U Type of Pump H P Sealing Material i Depth "hole plug" Well Destruction D Well Diameter t Piller Material i Depth Depth f i TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I i DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.l Installation will serve: Residence___- Commercial_ Other Number of living units: Number of bedrooms Character of soN to a depth of 3 feet: Water table depth SEPTIC TANK D Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. 8 Length of lines Total length/size FILTER BED D Distance to nearest: Well Foundation Property Line O SEEPAGE PITS 11 Depth Size Number SUMPS Lt Distance to nearest: Well Foundation Property Line ` DISPOSAL PONDS O 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 IM San Joaquin County 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 shell 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 followin ' "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa lion laws of Califo The applicant s of o uired in ti o plete drawing on reverse side. Project Engineer Date: 3-19-92 Signed X Title: EPARTMEM USE ONLY � Application Accepted by C..,_ Data �x,a� Z- Area 0 �ft.,hs4D f4drlc."+6t A&%"- Pit or Grout Inspection by Date Final Inspection by Date ,Jo lwe DFre-rE Additional Comments: '�r ,S� � Applicant - Return all copies to: San'Joaquin County Public liealth Services Environmental liealth Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 .� FEE AMOUNT DUE AMOUNT-.'REMITTED CASH RECEIVED BY DATE PERMIT'N0. INFO CASH EN fY21 INEv.I/AW 2 V 3 C EH tt