90-968 - Laserfiche WebLink

Home Browse Search

it �T f r APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE TON AVE., STOCKTON, CA t Telephone (209) 466-6781 I PERMIT EXPIRES TYEAR FROM DATE ISSUED I (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaqulrt County Ordinance eNo,.-.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health �istnct7, Job1Add4ss _J_/_b7J MancUso Rd city Tracy Lot Size_42 ACrPS PM Owner's Name PoTbo ;:Realty Address Phone 835 4949 Contractor Hennings S Bros. Address 3525 Pe I anda l M License No. 290813 Phone TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ "!PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST::.SEPTIC TANK none SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATIQN; WELL PITS ISUPS_ , M _____4 INTENDFD USE TYPE OF WELL PRO13LEM AREA CONSTRUCTION SPECIFICATIONS ! ❑ Industrial- iD Open Bottom ❑ Manteca I Dia. of Well Excavation Dia. of Well Casing Err CX Domestic/Ph,vate .[X Gravel Pack A Tracy I Type of Casing PVA t Specifications ( FI Public F Other F1 Delta Depth of Grout Seal Mlv_ Type of Grout Bentonite I I Irrigation Approx. Depth I 1 Eastern Surface Seal-Installed by driller Repair Work Done ❑ Type of Pump H.P, State Work Done_ Well Destruction ❑ Well Diameter -7 Sealing Material (top 56') Depth /90 Filler IMaterial iBelow 50'1 —_ TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIR/ADDITION i 1. DESTRUCTION i I (No septic system permitted if public sewer is �1 " *t available within 200 feet.) lJ Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms I Charactei of soil to a depth of 3 feet: p Water table depth SEPTIC TANK 0 Type/Mfg �` Capacity No. Compartments PKG. TREATMENT PLT. CJ Method of Disposal Distance to nearest: Well Foundation Property Line i� LEACHING LINE L) No. &-Length of lines M Total length/size FILTER BED Ll Distance to nearest: Well Foundation- Property Line SEEPAGE PITS I 1 Depth ' Size Number SUMPS Ll Distarice to nearest: Well J Foundation Property Line DISPOSAL PONDS L-A I hereby certify that I haveiprepated 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 Di3trict. ti Home owner or licensed agent's signature certifies the following:,J'I certify that in the performance of the work for which this permit is issued, I shall not employ any person in suchlimanner 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 workman's compensa- tion laws of California." I The applicant must call for,all required inspections. Complete drat ing on erse side. Hennings Bros. By M 4--20-90 Signed X Title: Date: FQR1EPAR1AENT USE ONLY Application Accepted by Date77 / Z Area Pit or Grout Inspection by,: Date Final Inspection by Date Additional Comments: —: fa � `�0 '1 ❑ Stk 466-6781 ❑iLodi -3621 ❑ Manteca 623-7104 ❑ Tracy 835-6385 Applicant- Returnall copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 r < a 7--'---=—'ter.-. FEE r INFO AMOUNT DUE! AMOUNT REMITTE9 CA RECEIVED BY DATE PERMIT NO. a.EH 13-24IREV. r EH 14-28