89-627 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR 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 Aegulativns of the San Joaquin t Local Health District. I Job Address 9729 North Hildreth Lane ockton 1 City StLot Size PM Owner's Name John F. Bahnsen Address 9729 N Hildreth Lane Phone Contractor_ Clark Well It 1 I Address 2024 E Charter 317560 ' TYPE OF WELL/PUMP: Wa3T License No. Phone 462-7676 NEW WELL IA WELL REPLACEMENT ❑ DESTRUCTION ❑ I PUMP INSTALLATION M: SYSTEM REPAIR ❑ DISTANCE TO NEAREST: SEPTIC TANK OTHER ❑ SEWER LINES __,� DISPOSAL FLD. FOUNDATION AGRICULTURE WELL PROP• LINE INTENDED USE OTHEA WELL PITS/SUMPS TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industria! j .❑�ppen-Bottom... .. ❑ Mant�c� ❑ Domestic/Private; -Ata-of Weil Excavation �T N _ Dia. of Well Casing ❑ Gravel Pack ❑ Tracy T i 1 Public Type of Casing ' Specifications 1-1 Other n Delta Depth of Grout Sea! ' I I Irrigation 4 Type of Grout _Approx. Depth I I Easterrk Surface Seal Installed b 6 Repair Work Done ❑ Type of Pump Sub H P Y Well Destruction ❑ Well Diameter 6State Work Done_ Installed `Sealing Mateq'ial (top 50') Depth ?Filler Material (Below 50'1 ? -J TYPE OF SEPTIC WORK; NEW INSTALLATION I I REPAIRIADDITIDN i I DESTRUCTION i I (No septic system permitted if public sewer is Installation will serve Residence t R available within 200 feet.l Commercial' Other__ Number of livingunits: a " - t Numb' bedrooms 1 f t Character of soil to a depth of'3 feet:r- �. : T r SEPTIC TANK Water table depth ❑ Type/Mfg3 1 r '� ' �.� ► -,� � _ PKG. TREATMENT PLT.i❑ ' I Capacity No! Compartments i Method of Disposal Dista ;y. nce to nearest: Well Foundation Property.Line LEACHING LINE r I f . No, & Length of lines I .. § i FILTER BED Y - = r- ¢ Total length/sizer Q Distance to:nearest1:___ r Well oundaIion ? f Property;Line SEEPAGE PITS I I Depth .- i.�.r,.<.s. 1. ..r,Sizers — Number SUMPS L7'•-•Distance-to-nearest. —Well» "" Y DISPOSAL PONDS ❑ . r Foundation ` 1 operty Line�� I hereby certify that I'hbve prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and ` rules and regulations cf.,the fan Joaquin Local Health District. Home ow r licensed " e is signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ a pe son ins ch nner as t come su ct to workman's compensation laws of California."Contractor's hiring or sub-contracting signature n certifies th foll wing: I ce if hat i e rforma of the work for which this perm is issued, I shag employ tion laws C "ornia. _ P p y persons subject to workman's go pensa- 4 The applic t I ui d s i nsmplete drawing on reverse side. r Signed S 'C- Title: Tres 27 March 89 t ate: D FORD PARTMENT USE ONLY ; Application Accepted by Date Area o Pit or Grout Inspection by i I Date— Final Inspection by Additional Comments: Date ;.,..—p,•Stk-466-678 U—[] L.oat 369-3624-9 sfvlanteca Applicant- Return all copies to: -a23-7404-0 TracY.�-..835 638ar _ P 6vironmental Health Permit/Services 1601-E.-Haialton Ave., P.O. Bax 2009 Stk., CA gel i r r FEE AMOUjb�UE CK INFO AMOUNT REMITTED RECEIVED BYCASH DATEPERMIT'NO.+.EH 13-24 IREV.l i ri 5l EH 14.26