90-3137 - Laserfiche WebLink

Home Browse Search

t APPLICATION FOR PERMIT : PAYMENT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL.i ON AVE., 5TOCKTON, CA RECEIVED Telephone (209) 466-6781 OCT 2 g 1988 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED SAIN JOAQIJ1 N (:I)UN T Y (Complete in Triplicate) PUBLIC HEALTH sNRVICES ENVIRONMENTAL I•{�p� r SrI f��r. d."T'ft$�{��iCa�li'911�rs Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein describe 1 made in compliance with San Joaquin County ordinance No.549 for sew ge or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health DistricI. r2 —0V'I S'_ .t'n sYLAx 3 77`"cii..��""..!! a. 90'x85'.— r PM Deue1 Vocational Institute city Trac Lot Size - — 2Y2 Job Address X100 P Street Suite 3460i�G) G1 b State o£ California ,r,arp„to, GSA 95814 hone {916)321-8772 Cali]ornia De t. of Ge ral Ser s Owner's Name k(a�^ '�,t QSa 4 r t.A g tG 3G /—U7�3 j 633 Brewer Koh /f6se4. � cr LEt. Gx7 — 9GGv Contractor All Terrain Dri Address P1e�t Grove CA 9%ffi License No. Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER M GeotediniCa1_ Boring, DISTANCE TO NEAREST: SEPTIC TANK SEWER SEWER LINES 60' DISPOSAL FLD. PROP. LINE i — FOUNDATION 10 AGRICULTURE WELL OTHER WELL PITS/SUMPS kINTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS N/A ❑ Industrial ❑ Open Bottom ❑ Manteca Dia.of Well Excavation f Dia. of Well Casing L] Domestic/Private ❑ Gravel Pack �l Tracy Type of Casing N/A Specifications {1 Other Delta Depth of Grout Seal Type of Grout CEnmt--$�9n t FI Public N/A I I Irrigation - ---Approx. Depth i I Eastern Surface Seal Installed by H.P. State Work Done Repair Work done ❑ Type of Pump Cement Bentonite Grout (� Well Destruction ❑ Weil Diameter Sealing Material atop 50'i N/A Depth - Filler Material (Below 50'1 TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAIR/ADDITION I I DESTRUCTION I I fNo septic system permitted if public sewer is available within 200 feet.i Installation will serve: Residence Commercial_ Other r Number of living units: Nu,bar of bedrooms Character of soil to a depth of 3 feet: Water table depth ICapacity No. Compartments f SEPTIC TANK 0 Type/Mfg PKG. TREATMENT PLT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line kI F LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line 1 Number SEEPAGE PITS I I Depth Size SUMPS L-i Distance to 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 regulations of the San Joaquin Local Health D%trict. 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 's compensation laws of California.'”Contractor's hiring or sub-contracting signature employ any person in such manner as to become subject to workman 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 f all requir inspections. Complete drawing on reverse side. � Signed X Title: Project Engineer Date: October 26, 1990 OR DEPARTMENT USE ONLY '} Application Accepted by Date Area o` Pit or Grout Inspection by Date Final Inspection by Data / Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca -7104 ❑ Tracy 835-6385 Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2Q09, Stk., CA 95201 l rJJ )C�AASH/ CAMOUNT �d✓ P� �j �COJ��t�P P%FEE RECEIVED BY DATE PERMIT-NO. INFO DUE AMO[/U�NT REMITTED ♦.EH13.241REV.r/951 EH 14-26 I { I