89-2706 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA REQ EVVF Ohm D Telephone (209) 466-6781 ";PERMIT EXPIRES 1'YEAR FROM DATE ISSUED NOV 2 1989 (Complete in Triplicate) ENVIRONMENTAL HEALTH � Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the war cP flhlLUrit ..VMAIication is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1662 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. ,) _ Job Address 1444 West Main Street Ripon Lot Size 5. 47 ac PM City i o er s venue Owner's Name Apartments Ltd Address 1444 West Main Street Phone 599-7161 Roberts Avenue ContractorApartments Ltd Address 1444 West Main St License No. N/A Phone 599-7161 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION PUMP INSTALLATION ❑ SYSTEM REPAIR Cl OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 150' SEWER LINES N/A DISPOSAL FLD. N/A PROP. LINE N/A Dr We 11 FOUNDATION 601 AGRICULTURE WELL N/p' OTHER WELL N/A PITS/SUMPS "IfQTENDEDUSE�"""~"'"TYPE"OF'WEL-L'"`"'�PRgBL'EM AREA—CONSTRl'JCTION-SPECIFICATIONS C1 Industrial ❑ Open Bottom - Ll Manteca Dia. of Well Excavation Dia. of Well Casing 611 ❑ Domestic/Private N Gravel Pack ❑ Tracy Type of Casing PVC Specifications I'1 Public ❑ Other/ s 171 Delta Depth of Grout Seal Type of Grout I I Irrigation 6�..Zpprox. Depth l 1 Eastern Surface Seal Installed by - Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction ) Well Diameter Sealing Material (top 50') Concrete Slurry _ Depth Filler Material IBelow 50'1 Concrete Slurry F TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION f I DESTRUCTION I DgNo septic system permitted if public sewer is ^� available within 200 feet.) Installation will serve: Residence"—Fornmercial— Other Number of living units: `��Number of bedrooms droom ... Character of soil to a depth of 3 feet: d m Water table depth 40 ' = 1 SEPTIC TANK ❑ Type/Mfg;) G481qtcTete Capacity . Compartments 2 PKG. TREATMENT PLT. ❑ Method of Disposal r Distance to nearest: Well Foundation Property Line F I LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to'nearest: Well Foundation Property Line iI SEEPAGE PITS ( I Depth I Size Number SUMPS ❑ Distance toynearest: Well Foundation Property Line DISPOSAL PONDS ❑ '..'� I h'�ereby certify that I have prepared this application and that the work wall be done in' ccordance with'San Joaquin bunty ordinances, state law's, ander 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's compensation laws of California." Contractor's hiring or sub-contracting signature M certifies the following: "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 required in ctions. Complete drawing on reverse side. Signed X,r- �' _ Tice: Partner (Owner ) Date 11/1/89 it FOR DEPARTMENT USE ONLY 4 Application Accepted by Data V, � oe Area w Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy B35-6385 i Applicant - Return all copies to: Environmental Hearth Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 ti FEE I AMOUNT DUE ' AMOUN7 REMITTED CK INFO 'RECEIVED BY DATE PERMITNO. r a.EH1 -141REV.I/K51 t 111-3-8i �^��7 4 EH 14-28 I