92-2808 - Laserfiche WebLink

Home Browse Search

.. i ,. APPLICATION r z N'. SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ig13D ENVIRONMENTAL HEALTH DIVISION ! 1445 N SAN JOAQUIN, PHONE (209)468-3420 f. . P 0 BOX 200911, STOCKTON, CA 95201 :A 'PERMIT EXPIRES 1 YEAR FROM DATE ISSUED :(Complete .iia Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application 1s made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. ji Job Address 9020 E. L A T H R O P RD. City MANTECA Lot Size/Acreage `-1 Owner's Name FRANK CARLOS. Address 9020 E. LATH ROP , MANTECA - Phone 239—4 735 '.f Contfactor HEMVINGS BR05. DRILLING- Address .aS2.5 P F L A N D A I_F A V F _ License No. 29081.1 Phone 545-1185 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT E. DESTRUCTION 00 Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR 0 OTHER O Monitoring Well (3 , DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ i INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C-1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing P Domestic/Private ❑ Gravel Pack ® Tracy Type of Casing_ Specifications I'1 Public t' Other i C1 Delta Depth of Grout Seal Type of Grout I I Irrigation W.Approx. Depth I I Eastern Surface Seat Installed by Repair Work Done 0 Type of Pump H.P. State Work Done_ Well Destruction IX Well Diameter fill Sealing Material & Depth _DEN TT O N I T F Depth Filler Material 6 Depth, - TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION i I (No septic system permitted if public sewer is availabie within 200 feet.l Installation will serve:N Residence,__.._.= Commercial_,___. Other Number of living units: Number_of bedrooms m Character;Ofioil'io.-a depth of 3.feet`E'. Wattar`tabledepth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG...TREATMENT PLT, 0 Method of Disposal Distance to nearest: Well Foundation Property Line } LEACHING LINE: ❑ No. S Length of.lines Total length/size FILTER BED 1-7 Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth f Size Number SUMPS LI Distance t0 nearest: Well 'Foundation Property Line f DISPOSAL PONDS ❑ E' i 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 County Home owner or licensed agent's signature oenifies 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." Contractor's hiring or sub-contracting signature certifies the fotlowing: "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 r fired inspections. Complete drpwing on retierse s e Signed Titl Date: _ AUG-'- 10 , 1992 FOR DEP AR ENT USE ONLY p W ceptad by Data —D_"`� Z– Areapica by Date .Final Inspection by.. P: — Date Additional Comments-. { • Applicant - Return all copies`-to: San Joaquin County Public Health Services Environmental Health Permit/Servi'ces 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE INFO AMOUNT DUE '` AMOUNT REMITTED CK ASN` RECEIVED 8Y DATE PERMIT NO. EK tR[V.tiKEl W� �O' �� @ �V•E]Q f 14.26 2 5Z-2Bo8