83-1319 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E. HAZELTON AVE., STOCKTON, CA PERMIT NO. Telephone (209) 466-6781 DATE ISSUED PERMIT EXPIRES 1 YEAR FROM DATE ISSUED W (Complete in Triplicate) j Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein l?5 described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. -� Jab Address A Subdivision Name Owner's Name CATTF- CEDER Address 1 340 W. WASHING'T'ON Phone g44_=;Rn0 Contractor's Name WORLD EN'T'ERPRISES License No. h5964 _ Phone 466-0717 TYPE OF WELL/PUMP WORK: NEW WELL F] WELL REPLACEMENT DESTRUCTION U 1 PUMP INSTALLATION F-1 SYSTEM REPAIR OTHER [7j- DISTANCE DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial U Open Bottom ❑ Manteca Dia. of Well Excavation LJ Domestic/Private F_� Gravel Pack Tracy Dia. of Well Casing 17 Public F-10ther Delta Type of Casing F, irrigation Approx. Eastern Depth Specifications [ Cathodic Protection Depth of Grout Seal 17 Geophysical Type of Grout U Other Surface Seal Installed by Repair Work Done [J Type of Pump H.P. State Work Done Well Destruction U Well Diameter Sealing Material (top 50') , Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION LJ REPAIR/ADDITION F-1 (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial Other Number of living units: Number of bedrooms Lot size Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK F-1 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Type/Mfg Capacity Method of Disposal SEWAGE STEM Distance to nearest: Well Foundation Property Line DEST CTION LEACHING LINE U No. & Length of lines Total length/size FILTER BED Distance to nearest: Well Foundation Property Line SEEPAGE PITS ❑ Depth Size Number SUMPS U Distance to nearest: Well Foundation Property Line DISPOSAL PONDS [D 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 Local Health District. 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 compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that is the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensation laws of California." The applican mil r �]1 equired inspections. Complete drawing on reverse side, Signed X / K��/ Titl Date: F PAf NT USE ONLY q ///nnn Application Accepted by �,tnr✓\Area 5tk 466-6781 Additional Comments: Lodi 369-3621 Pit or. Grout Inspection b Date Manteca 823-7104 Final Inspection by Date ��U//3/�(3 L7 Tracy 835-6385 Applicant - Return all copies to: E ironmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE BASE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. INFO �� to EH 13-Z4 REV. 10/82 10/82 500 14-26 LJ"