SR0084855 - Laserfiche WebLink

Home Browse Search

SA �JAQUIN COUNTY PUBLIC HEALTE ERVICES P SN V I ROMU NTAL HEALTH DIVISION > Z ` r 445 N SAN JOAQUIN, PHONE (209)468-3420.v60 P O BOX 2009, STOCKTON , CA 95201 S�P� 15' 5�g�2 P(S JO'4QtJIN PERMIT E%PCES (Compete YIIARripFROM eaDATE e) ISSUEililsfVIRONj - �AL A T[?V, fy Application is hereby trade to San Joaquin County for a permit to construct and/or install the work herein described. lTHYim application is made in ce®pliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joanuin County Public Health Services. _ Job Address Owner's Name7)�W1a1jJk Address Contractor TYPE OF WELL/PUMP: DISTANCE TO NEAREST: Address Lot Size/Acreage 0 �C LicensePht�,�-- NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well PUMP INSTALLATION ❑ SYSTEM REPAIR LJ OTHER ❑ Monitoring Well SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE W LL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONS t N 0 C] Industrial ❑ Open Bottom ❑ Manteca Dia. o1 Well ELca�cji EI Domestic/ Private I_] Gravel Pack ❑ Tracy Type ofPi — 1.1 Public El Other n Delta Dept h�1Mr or ,t��`th I � Type ° I I Irrigation _ Approx. Depth I I Eastern Surfac6rIbM Repair Work Done 0 Type of Pump H. P. �� l��g Well Destruction ❑ Well Diameter Sealing Materi ii - Depth Filler Materiel i Depth: iUl�!!ln TYPE OF SEPTIC WORK: NEW INSTALLATIONREPAIR/ADDITION i I DESTRUCTION I I INo septic system permitted available within 200 feet.) Installation will serve: Residence Commercial _ Other Number of living units: —t— Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK. X Type/Mfg Capacity 00o. Compartments _ PKG. TREATMENT PLT. ❑ -_�4"C., Method of�psal _ Distance to nearest: Well Foundation s�Z— Property line LEACHING LINE FILTER BED SEEPAGE PITS SUMPS nicoii>;er`vnrvnS ❑ No. & Length of lines Total n Distance to nearest: Well Foundation I I Depth Sire LI Distance to nearest: Well Foundation — Property Line Number Property Line public sewer is 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 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." Contractor's 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 workrnen's compensa- tion laws of California." The apdicantpµrst 9iip for all rg 'red Inspect. Complete drawing on reverse i e. Signed .�� Title: 4OLV f � Date:_ ONLY Application Accepted by Pit or Grout Inspection by Additional Comments: Date Area _ ZE, _ Date Final Inspection by Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Serviees 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 �1a r• • EM 13.24 IREV. L/ A 5 EH 1478 Date FEE INF AMOUNT DUE AMOUNT REMITTED CK RECEI Eg BY ATE PERMIT NO. 5V17" f �3