86-815 - Laserfiche WebLink

Home Browse Search

APPLICATIONFOR PERMIT .,., ,, SAN-JOAO.UIN`LOCA'HEALTH DISTRICT 1601E HAZELTON AVE., STOCKTON, CA p r� Telephone.(2Og? 466=6781 301 ;;PERMIT EXPIRES`1-,YEAR'FROM-DATE`1SSUE`D` (Complete In Triplicate)' ... ,.: ;;'`uta u "?` This application is per to construct andlor insaipldl the Rules and 1Regulat ons oftithe San Joaquin Application 'for sewage or No. 1862 for well/pump a "«� location is hereby made to the San Joaquin Local Health District or U t made in compliance with San Joaquin County Ordinance No 549 j x �' t. -- } Local Health Distric - PmcY�r', e k Lot Size t City gP.�tiJ� . Job AddressPF+one - 1 a Address QO5!2. I -Owner's-Name 1 U( Phone �Z License No. - to Address DESTRUCTION ❑ ELL 13i Contractor WELL REPLACEMENT ❑N W OTHER j TYPE OF WELL/PUMP: SYSTEM REPAIR ❑"` PROP. LINE PUMP INSTALLATION 11 E i. DISPOSAL FLD.— E. SEWER LINES J— OTHER IWELL� PITSISUMPS I` DISTANCE' NEAREST: SEPTIC TRNK �- AGRICULTURE WELL ^ FOUNDATION INTENDED USE TYPE OF WELL PROBL CONSTRUCTION SPECiFICATl0N5 Dia. of Well Casing El Bottom ❑ Manteca Dia. of Well Excavation Specifications ❑ Industrial ❑ Tracy; Type of Casing Type Grout ❑ Domestic)Private ❑ Gravel Pack I ❑ Other k 4a -..,<❑-De1ta=��-.----�"Oepth of Grout Seal 1-- _ l ❑ Public th ❑ Eastern_- Surface Seal Installed by �pprox=-Dep State Work Done i ❑ Irrigation a a �•��- °,�'"" H.P. - = Type of Pump Repair Work Done ❑ 'Sealing Material Itope50'1. W ❑ Well Diameter a ell Destruction Z! 1. Filler Material (Below 50'1 Depth tic system permitted if public sewer is i .available within 200 feet.} TYPE OF SEPTIC WORK: NEW INSTALLATION i� REPAIR/ADDITION ❑ D YSTRUCTION ❑ lNo sep h Other — ! Installation will serve: Residence Commercial Number of living units Number of bedr Dins , �, Water table depth F Character of soil to a depth of 3 feet: d� No. Compartments n ;Capacity r « SEPTIC TANK It' Type/Mfg ' - Method of Disposal PKG. TREATMENT PLT.❑ '/�� ,. Property Line I � Foundation I Distance to nearest: Well a f ...., 167 ;,- � - � Total length/size � LEACHING LINE ®' No. &Length of lines r 2 ht' Property Line FILTER BED ❑ distance to nearest: Well Foundation y — Sized s" ` Number SEEPAGE PITS ❑ --Depth Foundation Property Line I� SUMPS ❑ ' Distance to nearest: Well: f r r s DISPOSAL PONDS ❑ with San Joaquin ordinances, stats laws, an I hereby certify that I have prepared this application and that the work will be done in accordance county 1 certify tfii9t iii the performance'of the work for which this permit is issued, I shall not rules and regulations of the San Joaquin Local Health District Home owner or licensed agent's signature certes the foto workmanllowing: ' ersons subject to workman's compensa employ any person in such manner as to become subject the work for which this e m laws issued, shall empty ptors hiring or sub contracting signature certifies the following:'I certify that in th tion laws of California" 4 Ucan St or req red spec' Complete drawing on�re else side. The app' Date: } Title: Signed RTME�71f5E ONLY -FOR DEPA 3# ! Area �-� �'� +�•Date C Lotion Accepted by [[ Date � inaV Inspection nspection by `�' >�i5-6385 � ' Additional Comments: ❑ Manteca 823-7104 ❑.Tracy ❑ Stk 466.6781 ❑ Lodi 369-3821 Applicant- Return aN copies to: Environmental Health Permit/S ervices 1601 E. Hazelton Ave., P.O. Bax 2009, Stk., CA 95201 BY DATE _ PERMIT`NO. t.rt " ' RECEIVED .��. FEE: AMOUNT DUE AMOUNT REMITTED CASH INFO f 741-7(`gb +EH t3-241REV.r/") 7� +Co p .. ., _..� ... .... �.. EH 1426 - .�...-...,� .. . . -_}• ..... s w. -