SR0001430 - Laserfiche WebLink

Home Browse Search

Date 4-KA4A-V Final Inspection by FOR DEPARTMENT USE ONLY Date Application Accepted by Pit or Grout Inspection by Additional Comments. Services. Appl ca application is made in comp Joaquin County Public Health AVENUE 1 41.3 11 itIET YOSEmirE City .4I4NTEcA Lot Size/Acreage P16- X IC Arrei4 Date: i -ci 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 County 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 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 mu ca for all ed inspections. Complete drawing on reverse side. Title: SE)%lie.Q .S Area IN COUNTY PUBLIC HEALTH SERVikatillITIJ EN IRONMENTAL HEALTH DIVISION 514AN JOAQUIN, PHONE (209)468 -3420NOV 1 01993 BOX 2009, STOCKTON, CA 95201 EXPIRES 1 YEAR FROM DATE ISSUE& VIRONMENTAL HEALTH PERMIT/SERVICES (Complete in Triplicate) APPLICATION SR# AID# FAC# INV# ounty for a permit to construct and/or install the work herein described. This n Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San .. . Owner's Name TIME OIL Corn PA i4 y Address 2131 W. (....0111010DCQE UVA-y SEATTLE Phone 2-043-1"-"1495- I loi.IMEN Get •&-NviL T4t- Contractor SeAcoe/C eiLLING Address PIOAC*It 2Sqg i V° bA CITY License No.C5-7 61e/91/Phone SCX ) (2 1I -2.411 TYPE OF WELL/PUMP: NEW WELL CI WELL REPLACEMENT rl DESTRUCTION El Out of Service Well 0 0( ''' PUMP INSTALLATION 0 SYSTEM REPAIR CI OTHER,. Moniqr ing Well 5011- LiCQ•kzan DISTANCE TO NEAREST: SEPTIC TANK AiA SEWER LINES SC i DISPOSAL FLD. NA PROP. LINE 1 6- ' FOUNDATION 20 ' AGRICULTURE WELL — OTHER WELL .— PITS/SUMPS — INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 1.1 A [1 Industrial 0 Open Bottom )( Manteca Dia. of Well Excavation Dia. of Well Casing Cl Domestic/Private 0 Gravel Pack Li Tracy Type of Casing Specifications 1 .1 Public Cl Oyter El Delta Depth of Grout Seal Type of Grout I I Irrigation /5 Approx. Depth I I Eastern Surface Seal Installed by . Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction 0 Well Diameter Sealing Material I. Depth GEN 7-04 1 r E cent ENT SW le.C.4 421 so I- :;t1-rneL,416 Depth Filler Material & Depth IS ' To 6 g4 I) TYPE OF OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence Commercial Other ______ _ Number of living units. Number of bedrooms Character of soil to a depth of 3 feet • Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PIT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 Signed X Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, 201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. )„,<,........... ,_-,-.A4c/25-' --y 7 ' ''''''-- //1 c-/7.) Meti!----,. 'i- . EH 1124 IREV. SI EH 14.28