92-3745 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES � � ENVIRONMENTAL HEALTH DIVISION PAENT k 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCgTON, CA 95201 i ►1 NOV 17 1992 r PERMIT EXPIRES 1 YEAR FROM DATE ISSUED SAN i0AQW1N COi,NITY � (Complete in Triplicate) MJBLIC HEALTH,, Ei, V!Ct _S made to San Joaquin County for a permit to construct and/or install the Application is hereby Regulations of San application is made in compliance w + ith San Joaquin County Ordinance No. 51+9 and 1862 .and the Rules and Josquin County Public Health Services. Js•�� , � f t' Lot Size/Acreage Job Address 100 City -- Phone ' Address Owner's Name 11 A r �. `Z Phone ✓ 1 (cense No. Gontlactor + r. /�' Address W LL REPLACEMENT ] DESTRUCTION U Out Monitoring Well TYPE OF WELL/PUMP. N W WELL ❑ OTHER O PUMP INSTALLATION SYSTEM REPAIR.CI SEWPROP. LINE t ER LINES �— DISPOSAL FLD. 'DISTANCE TO NEAREST: SEPTIC TANK � PITS/SUMPS ___ OTH.ER.WELLr---- �« -.._FOUNDATION=. --AGRICULTURE,WELL_ ___-I"�� INTENDED USE TYPE OF WELL ' PROBLEM AREA' CONSTRUCTION Wall ION_anon SPECIFICATIONS pia. of Well Casing Dia. of Well Excavation (� ('] Industrial . ❑ Open Bottom ❑ Manteca � Specifications • `x`11 ❑ Tracy Type of Casing. s C:1 Domestic I Private ❑ Gravel Pack Depth of Grout Seal` i " '" --Type of Grout I'! Public Cl Other n Delta ' (Surface Saw Installed by O —.Approx. Depth 1 I Eastern � } I I irrigation "% State Work Done of Pumps H.P, AA Repair Work Done U Type 4terial b` Depth I flaps Ffs Well Destruction ❑ Well Diameter Filler8l+isterisl b Depth - .. Depth- - ^ p 111`1111111I I'll WSTAj LATION 1 1 REPAIRlA TYPE OF SEPTIC WORK: NEW DDITION l I DESTRUCTIONI I evailablelw thin 200 feetc system .) it public sewer is Installation will serve: Residence ' Commercial Other --- , Number of living units: Number of bedroom" Water table depth Character of soil to a depth of 3 fest: ' Capacity__ ,--- No. Compartments SEPTIC TANK. ,❑ Type/MfgF t' �^ j Method of Disposal PKG. TREATMENT PLT.❑ r } � �-s Foundation Property Line�--' Distance to nearest: Well i Total length/size LEACHING LINE Ci No. & Length of lines - s _...Foundation�..--- Property Line--�-�---• FILTER BED n Distance io nearest: Well- t I ' v Size b Number SEEPAGE PITS l I Depth Property Line -- } SUMPS Ll-.Distance to nearest: Well Foundation . Dhereby L PONDS"I have 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'an o rules and regulations of the San Joaquin County g; „ Home owner oslonein ouch manna gas torbacoma sub ecalto w'orkman'srtcompensalion lawsoof Cel fornia." Contractor slhiringl orr sub contract ng signatus permit is issued, I shall re employ any pe certifies the following: u certify that s the performance of the work for which this permit is issued, I shall employ persons subject to workman's compens tion laws of California." I The applicant must ca for all required inspections. Complete drawing on rerrv��efseFside. F 1tJi,_:�� Date: !/ l - Title: _— - � Signed x , IF - :OR DEPARTMENT USE ONLY d Z / [•� Date Area---- f z - ; ! Application Accepted by Date Pit or Grout Inspection by Date - Final Inspection by i 4 Additional Comments: Applicant —Return all copies to: an Joaquin Environmentalounty Healthublic Health Permit/Servicesvices 445 H San Joaquin; P O Box 2009,- Stkn, CA 95201 GKPERMITNO. FEE AMOUNT DUE AMOUNT REMITTED RECEIVED By D E ' EK 13-24(REV.t I n S) t� EH 14-26 l ♦ F. -• -