90-870 - Laserfiche WebLink

Home Browse Search

e 1 r APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 0 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 i 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. Job Address SE Corner March.Lane and West Lane Stockton City Lot Size PM Owner's Name Unocal Corpo Lion Address 1 2175 North California Blvd. Phone 415-945-7676 Contractor Wayne Drilling Address P.O. Box 726, Lincoln license No. 376345 phone 916-965-935 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ -OTHER ffSoil borings w/no wdl .DISTANCE TO NEAREST: SEPTIC TANK Nnnp SEWER LINES None.._._ DISPDSAL FLDI1ID,II.�_ PROP. LINE �} inst 1 FOUNDATION _ Nnna AGRICULTURE WELL None OTHER WELL�O�tpITS/SUMPSNnriP`" ft {� INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of*l�¢ E4gavation inc Dia. of Well Casing NA 0 ❑ Domestic/Private ❑ Gravel Pack El Tracy Type of Casing NA Specifications ❑ Public f7 Other Cl Delta Depth of Grout Sea] 50 ft I Type of Grout I Irrigation —..Approx. Depth l I Eastern Surface Seal Installed by Wayne Drilling Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material hop 50'1 } Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION l 1 REPAIR/ADDITION l I DE=STRUCTION I I (No septic system permitted if public sewer is "\ ! Installation will serve: Residence Commercial— Other available within 200 feet.) Number of living units: Numbtter of bedrooms a j Character of soil to a depth of 3 feet:f Water table depth I SEPTIC TANK ❑ Type/Mfg. Capacity No. Compartments ' PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Wel! Foundation Property Line I i LEACHING LINE ❑ No. & Length of lines Tota! length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line (f� SEEPAGE PITS l I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ n I hereby certify that I have prepared this,application and that the work will be done in accordance with San Joaquin county ordinances, state:aw:, and 1` rules and regulations of the San Joaquin Local Health Di$trict. 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,. shll 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 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 mus for a squired inspections. Complete drawing on reverse side. Signed X I f Title: Project Geologist 4/1 1/90 Elois Frick — Date: i EPARTMENT USE ONLY Application Accepted by �:.�� Date – Ar Pit or Grout Inspection by Date Final Inspection Date _�� Additional Comments: Lo/ ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 t FEE qOUNT DUE AMOUNT REMITTED CK RECEIVED 6Y INFO CASH DATE +. /A P MIT'N EH 1321(REV –1 a�� Q EH 11-28 0 L�l D. RE, ��