92-4009 (2) - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERI[I T SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONh[ENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 KI JOB P 0 BOX 2009, STOCKTON, CA 95201 20-3694-01 PERMIT EXPIRES 1 YEAR FROM DATE ISSU}' �• Apo1 in Triplicate) Application is hereby made.to Ban J in oun y for a rmit to construct and/or install-the work herein described. This application is made 1n compliance vit San Josquin County Ordinance No. 549 and 1862 and the Rules and Regulations or San { Joaquin County Public Health Services. APN if243-32-17 and 243-30-02 Jack Tone Road & Hwy 99 City Ripon Lot Size/Acreage Job Address I -City of Ripon Address .254- North Wilma Ave,Ripon, CA Phone 599-2108 _ Owner's Name . f Contractor Spectrum/Kleinfelder Address 2825 E. Myrtle St. License No. 512268 Phone 948-1345 1 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT C} �E3iItt7L'ft9irfOut ct-eerViveriJaft--S OTHERXX ° � PUMP INSTALLATION ❑ __� SYSTEM REPAIR•❑ 3 test borings DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PR6�-f_+m 15 to 50'de FOUNDATION AGRICULTURE WELL OTHER WELL fSlfhAPS p diameter INTENDED USE' TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Will use " n industrial ❑ Open Bottom ❑ Manteca- Dia. of Well Excavation D'a�f�Nell4'ahole u to • • e.0_"_-ierte p g [-1 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ TV bac fi I'1 Public Cl Other n Delta —Depth of Grout Seal �W holleses if groundwater I I Irrigation Approx. Depth t I Eastern Surface Senl Installed by - - Repair Work Done U Type of Pump H.P. T r State Work Done __ encountered.' f Sealing Material i Depth Well Destruction ❑ Well Diameter w ' Depth Piller Materiel Z Depth E �` TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIRIADDITION [ I DESTRUCTION l I INo septic system permitted if public sewer is available within.200 feet.) I Installation will serve: Residence__ Commercial Other t Number of living uniti- Number of bidrooms "- f Character of soli to a depth of 3 feet: Water table depth 1 SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments \� PKG. TREATMENT PLT.0 � Method of Disposal Distance to nearest: Well:- Foundation Property Line I .. LEACHING LINE ❑ No. & Length of linea Total length/size FILTER BED ❑. Distance to nearest:. -Well Foundation Property Line , e _ 1 a SEEPAGE PITS t I Depth _f Size Number SUMPS LI Distanceto nearest: Well° Foundation Property Line 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 regulatkm 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." Contractors hiring or sub-contracting signature certifies the following: "I canify'that in the perlo, i nce of the work for which this permit is.issued, I shall employ persons subject to workman's compensa- tion lours of Catifor r The applicant 11 r all uired ins c'o a drawing on reverse side. Signed « Title: Project Engineer Date; December 28, 1992 FO DE RTMENT USE,ONLV f Application Accepted by -7h-41M 45)�e Z111140 Data f Z A Pit or Grout inspection by ~t Data Final Inspection by Data Additional Comments: 3 Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services any f 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 aAFEE INFO AMOUNT DUE AM UNT REMITTED CK RECEIVED SY. ISAdE PERMIT NO. a till 1124 111C1r.r N 51�� 0 , , . i — . A -A/-')L En 167e "��