90-2255 - Laserfiche WebLink

Home Browse Search

,✓ ' APPLICATION FOR PERMIT �, ,•r SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 P 0 BOR 2009, STOCKTON, CA 95201 EXPIRES 1 YEAR FROM DATE ISSUED 2 (Complete in Triplicate) AU,G' _ 9i, Application is hereby made to San Joaquin County for a permit to construct and/or install th6Nvork(�� in R r�b,�eed. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Ruleik(=V 96' of San Joaquin County Public Health Services. 11tl-r r� �j�•r� Job Address Jack Tone & Doak Blvd City Ripon Lot Size/Acreage Lot #17,60'x1201 r Owner's Name Florsheim Bros. Address 1701 W. March Lane Ste D Phone 473-1106 Contractor Spectrum Address 2825 E. Myrtle Str. License No, 512268 Phone465-8712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION XOut of Service Well ❑ PUMP INSTALLATION 0 SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing C3 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications H Public FI Other n Delta Depth of Grout Seal Type of Grout I Irrigation 35 .Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction CX Well Diameter 2" Sealing Material & Depth Depth ?rj r Filler Material & Depth r TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I I o 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. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE L1 No. & Length of lines Total length/size FILTER BED 1-7 Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS L) Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 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 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 Calif The applican ust all for all required inspec ' Complete drawing on reverse side. Signed Title; Date: FO DEPARTMENT USE ONLY Application Accepted by Date � res Pit or Grout Inspection by Date Final Inspection by � Date Additional Comments: Applicant — Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., F 0 Boz 2009, Stockton, CA 95201 INFO AMOUNT DUE AMOUNT REMITTED R RECEIVED BY DATE PERMIT NO. . EH 14-24 rREV.i nal "`1 7^ EN X426 I