SR0003894 - Laserfiche WebLink

Home Browse Search

r: 0 SR # C3 SAN , AIN COUNTY PuaT,Ic ffEALTH , VICES ,NV IRONMENTAL HEALTH DIVISION AID 445 N AN JOAQUIN, PHONE (209)468-3420 I' OX 2009, STOCKTON, CA 95201 FAC # INV# PERM IT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) APPLICATION App cat on s in Geunty for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Lot Size/Acreage 1.5 .1o0P.aomss v.--, ....... G re./ koutic,c1 VAes Address (910) Main Si- 7ze. Z925- Phone(/'/) 7// '7( Owner's Name i TX ContractorS Q4 n........vv\ fz' i(p . Address 262,5 e": fi'lLi r 71-1.t License No. 51 2.2..c.g? Phone /6S-- 8 7i 2 TYPE OF WELL/PUMP . NEW WELL Ei WELL REPLACEMENT El DESTRUCTION El Out of Service Well Cl Monitoring Well PUMP INSTALLATION Cl SYSTEM REPAIR 0 OTHER x c SEPTIC TANK /1/# SEWER LINES Z.• 519 t DISPOSAL FLD. /VA PROP. LINE 24 / DISTANCE TO NEAREST: FOUNDATION fe) AGRICULTURE WELL /1/14 OTHER WELL 1114 PITS/SUMPS iiit -6 Ic ...P .,..__•,;.1. 1,...„,,,,:—.-.. 7, L t ,N1ENCED USE -7-Y PE :j-, ',•',•!.:LL 2 F1.;EL.E,:l :-FZEA CC;!•STP.LiCnnN czPEC!FC,t.7•10..NE . Cl Open Bottom 0 Manteca Dia. of tilisIFExcavation te" Dia. of Well Casing Cl Industrial Pack 0 Tracy Type of Casing Specifications El Domestic/Private 0 Gravel Cl Delta Depth of Grout Seal 415 41) C-te•C‘ce Type of Grout_egamgesi_Lakel> 1'1 Public I71 Other Depth I I Eastern Surface Seal Installed by SF dz..4-1-,....w. ar.pley-,..,it; c7,.. 1 kr, L. . I i Irrigation _ Approx. Done (3 Type of Pump H.P. State Work Done Repair Work Diameter Sealing Material Depth & Well Destruction Cl Well Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence Commercial Other _ _ Number of living units: Number of bedrooms _ depth of 3 feet: Water table depth Character of soil to a 0 Type/Mfg Capacity No. Compartments SEPTIC TANK 0 Method of Disposal PKG. TREATMENT PLT. Distance to nearest: Well Foundation Property Line . Cl No. & Length of lines Total length/size LEACHING LINE 0 Distance to nearest: Well Foundation Property Line FILTER BED PITS I I Depth Size Number SEEPAGE LI Distance to nearest: Well Foundation Property Line SUMPS nicprIcei PfINI1S 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 appli nt m at call for all r 'red i pections. Complete drawing on reverse side. Signed X .„1/W7 Title. gia1,1 4 5/01-al,/ Y-"Q/Or A 'F9R DEPARTMENT USE ONLY 0-513 1 5 '-`7° Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 Application Accepted by Pit or Grout Inspection by Additional Comments: Final Inspection by Date Date: Date Area (OR V Di 13-24 (REV, 1.431 FEE INFO 55 AMOUNT DUE AMOUNT REMITTED CK i CASH RECEIVED BY DATE _?///?..05et24x74 PERMIT' NO. gl? _129 izt.