93-0045 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES j ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 1 P 0 BOX 2009, STOC%TON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I (Complete in Triplicate) ! `Z(�-- 14-0-t I., Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance With San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health_Services., Job Add Ss �Lf � >z��6 -4 City City!uithnon Lot Size/Acreage Owner's Name t Address5 0 0 E. L o u.i z e Phone U8-5151 ContractorCeu2lfG ��+4 I Address_2024 E. CA;rz;a. _pa a License No3 Z Z 560 Phone TYPE Of WELL/PUMP: NEW WELL 11 WELL REPLACEMENT FJ DESTRUCTION X-kNt of Service Well ❑ PUMP INSTALLATION C] SYSTEM REPAIR Cl OTHER ❑ Monitoring Well DISTANCE 70 NEAREST: SEPTIC TANK SEWER LINES DISPOSAL. FLD. POOP. LINE FOUNDATION AGRICULTURE WELL __ OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS M Industrial C1 Open Bottom 0 Manteca Dia. of Well Excavation _ Dia. of Well Casing _ C 11 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_. Specifications 11 Public 1:1 Other f1 Delta Depth of Grout Seal Type of Grout I I Irrigation �-Approx. Depth I I Eastern Surface Soul Installed by Repair Work Done 0 - Type of Pump H.P, State Work Done Well Destruction i7 Well Diameter 1„�,� Sealing Material & Depth O r 5 0/ Depth 148 , Filler Material & Depth N 4 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 1 I DESTRUCTION I i INo septic syslem permitted if public sewer is I available within 200 feet.) Installation will serve: Residence— .Commercial— Other Number of living units: Numbersof bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg t. Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Ll No. & Length`of lines Total length/sire FILTER BED 0 Distance to nearest: Well Foundation Property Line y SEEPAGE PITS 1 ) Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 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.'' Contractors hiring or sub-contracting signature 1 certifies the following: "I certify that in the pirformance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of California." The applicant st all for II r ad n tion mpI drawing on reverse side. Signed # Title: V1 C.LC V -U _G Date: t FOR DEPARTMENT USE ONLY / Application Accepted by Date f�� Area Pit or Grout Inspection by / /Date Final Inspection y ate / 2 ? Additional Comments: ` ,�J,ie/ ��..., �s AG . ? Applicant - Return all copies to: San Joaquin County Public Health Services } Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 9520]- r , IEEEAMOUNT DUEf AMOUNT REMITTED CASH RECEIVEp BY RATE PERMIT NO. EH 1344 IREV,r 1 n SI ,D �Q !J� O Z �DO EH I4.2e Y/