90-2561 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN "COUNTY PUBLIC HEALTH SERVICES ; d j] ENVIRONMENTAL HEALTH DIVISION '1 1601 E. HAZELTON AVE. , PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 _PERX1T__EXPIRE$ 1 YEAR FROM DATE. I�g]VgD (Complete in- Triplicate) Application is hereby made to San Joaquin County for a permit to constrtict and/or install .the vork herein.described. This application is made in emviiance vith San Joaquin County Ordinance Ho.' 51+9 and 1862 and the.Rules and Regulations of San Joaquin County Public Health Services. Job Address J9 5 2 7 7 nn• Lot Size/Acreage _ 40 owner's Name Hogan Mfg . , Inc . Address 19527 South McHenry Phone (209)838-7323 Contractor Don Lambert & SorA@dress 121 "F" St'. Waterfc -lAnse No. A'561566 Phone (209)874-21 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well !J DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DfSPOSAL FLD. PROP. LINE E FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS X7 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing Cl Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications (1 Public I-1 Other n Delta Depth of Grout Seal Type of Grout 1 I laigalion —.Approx. Depth l I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction 1 Well Diameter 8'1 Sealing Material i Depth Concrete Depth 200' Filler Material & Depth Ain, 7401�7- TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is i available within 200 feet.} I 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 ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation Property Line I LEACHING LINE ❑ No. & Length of lines NSA, Total length/size ; FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth N/A Sire Number SUMPS LI Distance to nearest. Well Foundation Property Line 4 DISPOSAL PONDS ❑ r 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 i 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 appfican all ti wired ' ct s mpiete drawing on reverse side. Signed X Title. Controller Date: 09/24/90 FOR DEPARTMENT USE ONLY Application Accepted by ea Date �-� ,. � Pit or Grout Inspection by Date Final Inspection Da Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Razelton Ave., F 0 Box 2009, Stocktcn, CA 95201 FEE AMOUNT DUE AMDUNT REMITTED K RECEIVED 9Y DATE PERMtT NO, + INFO EH 11.24 SREV.1/rir EN i4.29 ,