87-3982 - Laserfiche WebLink

Home Browse Search

" APPLICATION FOR PERMIT SAN JOAO.UIN,LOCAL HEALTH DISTRICT , 1601 E. HAZEL I ON AVE., STOCKTON, CA' Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR.FROM DATE ISSUED .3'a+ :r (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_o-No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. # �[ _f "'-� 7t - Farnas_er.o. Estates � `t°�-13v- �7 �:rr�� .: r, ,. o Lynn C i r c l e r Job Address Lot #7 lgi-&a-- 1-� c Julie City Lot Size 250 x 2 0 0 PM racy Owner's Name Delta DeV- o Address P..0.._ BOX .7 414 _tck t 011_ Phone 9 31 -0343 Contractor HPnnincig Bro-e-_ Address 3525 Pelandale,Mod License No. 29083 Phone 545-1185 TYPE OF WELL/PUMP: - NEW WELL CX WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 1002 SEWER LINES DISPOSAL FLD. 1 0_0 ' }PROP. LINE 15 ,! i FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ pn�y ! INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS -4 El Industrial 11 Open Bottom ❑ Manteca Dia. of Well Excavation r1 pia. of Well Casing H L�*s IN Domestic/Private Gravel Pack Ill Tracy Type of Casing PVC Specifications ❑ Public 11 Other ❑ Delta !Depth of Grout Seal 1 0 0 t Type of Grout ❑ Irrigation ---Approx. Depth ❑ Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done L Well Destruction ❑ Well Diameter Sealing Material Itop 50'1 , Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is t available within 200 feet.) t » Installation will serve: . Residence_ Commercial—;,,Other I Number of living units: Number of bedrooms E Character of.soil to a depth of 3 feet: Water table depth " ' SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ „ 8 y, Method,of Disposal ':Distance.to nearest: Well Foundation Property Line t LEACHING LINE -�. ❑E No. & Length of lines Total length/size FILTER BED ❑i Distance to nearest: Well Foundation Property Line � P SEEPAGE PITS O' Depth' ' Size Number SUMPS ❑ 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 the San Joaquin Local Health District. 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 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." The applicant must call for all required inspections. Complete drawing on r94erse/ side. Signed X Hennings B r o s. B y Title: -M a 0 Date: 10-20-87 FOR DEPARTMENT USE ONLY h Application Accepted by _' Dater \� Area Pit or Grout Inspection by Datef C ___4 f Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 8354MS # Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazekon Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT`NO. } INFO ll lGCASH ° + EH 13-24(REV.t/9 s 1 EH 1428