CO0054218 (2) - Laserfiche WebLink

Home Browse Search

4 1: Application is hereby made to he San Joaquin Local Heelth made in compliance with San Joaquin County Ordinance No. Local Health District. (Complete in Triplicate) District for a permit to construct and/or install die work herein described. This OPPlication is 549 for sewage or No. 1862 lor werl/pump and me Rides and Regulations ol the San Joaquin Job A.,.5e,3s53 00,f-14,41RJ City Lot thee 2 . PM Plane Address Address 7h 7 c--7"_.4‘ License No.-?.?g22.6, Phone 36157,76765— rOi WELL REPLACEMENT 0 DESTRUCTION LI SYSTEM REPAIR 0 OTHER 0 GEWER LINES DISPOSAL FLD. PROP. LINE AGRICULTURE WELL OTHER WELL PITS/SUMPS C Industrial 0 Open Bottom 0 DomeatiC/Private 0 Gravel Pack Pubfic 11 Other ! I Irrigation ........Approx. Depth Repair Work Done 1.3 Type of Pump Wet Destruction 0 Well Diameter Depth Sealing Material (top W') Filler Material (Below 501 . .-- TIONeK REPAIR/ADDITION . I DESTFILICTION I I (No saw aeallarde INTENDED USE TYPE OF WELL PROBLEIV IA1 4. CONSTRUCTION SPECIFICATIONS 5,.. E1 Manteca Dia. of Well Excavation Dia, of Wed Casing 0 Tracy Type of Casing Specifications 171 Delta Depth of Grout Seat Type of Grout II Eastern Surlace Seel Installed by H.P. Stave Work Done Application Accepted by Pit r Grout Inspection by l'e,dditional Comments' FOR DEPARTMENT USE ONLY Oateiv2,- Date r?-tipeci Anel Insprection Date F2-1A47 TYPE OF WELL/PUMP: NEW WELL 0 PUMP INSTALLATION 0 DISTANCE TO NEAREST SEPTIC TANK FOUNDATION PLOT PLAN (Draw To Scale) SCALE "TO Names of streets or roads nearest to or bounding the property. Outline of the property, giving dimensions and North direction. Dimensioned outlines and locations of all existing and proposed structures, including covered areas such as patios, driveways and walks. Location of house sewer outlet, public sewer, sewage disposal system or proposed sewage disposal system. proposed expansion of sewage disposal system, or any other possible source of contamination. Location of other wells within radius of 150 feet on the property or adjoining properly. Location of sewage disposal system on adjoining property or within a radius of 150 feet. ...di 1111 I III _ APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Installation will serve: Residence _ Commerelel _40ttree Number of living units: _i_ Number adroom Character of sod ens depth of 3 lee, Water table depth SEPTIC TANK •yX Type/Mfg eee CePaChy /t0i(5 No. Compartments c2.. PKG. TREATMENT PLT. 0 ( / Method al Disport Well \-5:0---_ Foundation a.7(7.4 Property Line akc Distance to nearest: LEACHING LINE X No. & Length of lines 123 — LIC) Total tem:ph/sire in2e9 'gee FILTER BED 0 Distance to nearest: Well AOC' Foundation /ra Property Line SEEPAGE PITS 34 Depth .-25- Sirs CV Number I" SUMPS 11 Oistance to nearest' Well _Erc-r•D Foundation /et Property Line DISPOSAL PONDS I hereby caddy that I have prepared this application and that the work will be doria in eccordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin Local Health 09trict. Home owner or licensed agent's signature certifies the following: "I certify that ki the perlormance of the work for which this permit is issued, I shall not employ any person In such manner as in become subject to workman's corripensation laws of California." Contractor's hiring or•sub-contracting signature certifies the following: "I certify Mat in the performance of the work for v.fitch this permit is issued, I shall employ persons subject to!workman'et corripeasa lion laws of California." The applicant call for all spections. Complete drawing on reverse 91ez, Signed Xmt94 Title: Vor • Date' $0...raC r 27 O Stk 466-67131 0 Lodl 369-3621 0 Manteca 823-7104 0 Tracy 866-6385 Applicant - Return all copies to: Environmental Health Perrnit/Sarvices 1601 E. Hareiton Ave., P.O. Box 2C09, Stk., CA 96201 rleE INFO AmOUNT DUE AMOUNT REMITTED CI( i CASH RECEIVED RV DATE PERMIT. NO. • Iii 1114 IIIEV 51 EH 14 2.1 system permitted It public sewer is thin 200 feet I TYPE OF SEPTIC WORK. NEW INSTAL (”9R-1., en, Owner's Name -.S4L:Let/1_ 4111 se I Conttac