SR0082253 SSNL - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 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. Inh Address 16042 E. Baker Lane riry Linden Lot Size/Acreage Owner's Name C & A LaQC0arFii110 Address1 6042 F. Raker _ jai ncien Phone 209-887-3554 ContractorFi anee Drilles,Ine.Address P.O.BoX 64,Linden License No 377923 Phone 209-887-3554 - - T-YPE TYPE OF WELL/PUMP; NEW WELL ❑ WELL REPLACEMENT 171 DESTRUCTION JkOut of Service Well D _~T Y PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well f7 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _ _____ DISPOSAL FLD. - PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca — Dia. of Well Excavation Dia. of Well Casing _ Cl Domestic/ Private :'0fdravel Pack ❑ Tracy Type of Casing .------- --- Specifications I"1 Piiblic ��- -[ 1"Other- .1----fl-Delta- • � ------Depth of -Grout -Seal--- - -_ - - - - _Type.of.Grout- I I Irrigation _-_ Approx. Depth I I Eastern Surface Seal Installed by-bd,Ck.f1 . • ' - i Repair Work Done ❑ Type of Pump H, P. State Work tDon / " " T '``yn' ' Well Destruction L Well Diameter f!✓e,/- Sealing Material &Depth 9s�ck sand & r�r?dT1e1RL l! Depth W�e4W Filler Material 6 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewor 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: I - Water table depth w ~i SEPTIC TANK O Type/Mfg i Capacity No, Compartments _ PKG. TREATMENT PLT, O 1 Method of Disposal Distance to nearest: Well _- Foundation Property Line LEACHING LINE Ll No. to Length of lines _ Total length FILTER BED [.I Distance to"nearest: Well —_ Foundation ______ Property Line SEEPAGE PITS 11 Depth Size,___� Number SUMPS LI Distance t6 -nearest: Well Foundation _ _ Property Line DISPOSAL PONDS ❑ I nereoy cemty trial I nave 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 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, 1 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: "1 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." Theapplica must call t all u' speecions. Comploto drawing on reverse side. t signed x -- --_-- Tine: President ------ Date: 2/16/93,_ I FOR DEPARTMENT USE ONLY =-// Application Accepted by _�� --- ------ Date 12LkZ _ Area 1211 Pit or Grout Inspection by Date Final Inspection by _.. Date Additional Comments: /'17(AiL D((iS Ot/ F 3 ee- Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Dox 2009, Stkn, CA 95201 - EH 13 24 r/n5 EH 14.20 FEEINFO AMOUNT DUE AMOUNT REMITTED C K /t RECEIVED BY DAJE PERMIT N0. r / r :P