89-636 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL-HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone 091 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) application is n Ordinan o.549 for sewage or No. 1862 for well! ump and the Rues and Regulations of the San Joaquin Application is hereby made to the SanCouquin Local Health District for a permit to construct and/or install the,�w/o�rk herein described.This made in compliance with San Joaquin County C Local Health District. ///II�CCr t Lot Size{—Cd-- a�E But Job Address 2 ( ©, (y t o J O— 3 • f on Aiilllress ` 7/ 3 e��qq 'x-Owner's Na ,,f r. .€ r a Phones J License No Address r r"' Contras r ,� DESTRUCTION LJ NEW WELL ❑ WELL REPLACEMENT ❑ OTHER ❑ Y i TYPE OF WELLIPUMP: SYSTEM REPAIR ❑ PUMP INSTALLATION ❑ DISPOSAL FLD. PROP. LINE DISTANCE TO NEAREST: SEPTIC TANK 'i N SEWER LINES —_ — PITSISUMPS FOUNDATION AGRICULTURE WELL OTHER WELL ._—�— INTENDED USE TYPE OF WELL r,_-.rPROBL_ EM.AREA. CONSTRUCTION SPECIFICATIONS • Dia. of Well Casing f r— Manteca, Dia. of Well Excavation ❑ Industrial ❑ Open Bottom ; e a Specifications ❑ Gravel Pack �;' ❑ Tracy L.. Type of Casing - ❑ Domestic/Private i- f. Type of Grout P Other ❑ DeltaDepth of Grout Seal M Public Surface Seal Installed by I I Irrigation —.Approx. fJeptfi l Eastern State Work Done Repair Work Done [IType,of-Pump-:` - H.P. �; Seating Material (top 50'1 Well Destructic5n..- ' ❑ Well;Diameter —^-- "-�`� Filler Material (Below 501 Depth available within 200 feet.) �n TYPE OF SEPTIC WORK: NEW INSTALLATION RI 1745 ADDITION i I DESTRUCTION I 1 iNo Septic system permitted if public sewer is V i F i� k("` Other r Installation Will serve: Resi encs •��.Commercial i Number of living units: dumber bedr o s Water table depth Character of sod to a depth of 3 feet: ' Capacity No. Compartments ^ r SEPTIC TANK Type/Mfg t Method of Disposal PKG, TREATIiII PLT. L ❑ _ � FoundationProperty,Line N Distance to nearest: Well ` ` f e- ` f � T; T�tal lengthlsize f LEACHING LINE No. & Length of iines �� Property Line I FoundationQ-- 'f FILTER BED ` ❑ Distance to nearest: y Well 4 � E a r r Size Dumber SEEPAGE PITS / Depth --- Property Line-2%5— SUMPS 2% i SUMPS- � ❑ Distance to nearest:. Well - Foundation 1 +. DISPOSAL PONDS ❑ Sari I I hereby certify-that ('have prepared this application and that the work will be done in accordance with Sn Joaquin county ordinances, state laws, an shall not rules and regulations of the San Joaquin Local Health District. work for f Hssue ome owner or licensed nssuch rnannergas to become subjects to workman's rkman'srtcoythat inmpensation lawsoof Californian"Contractor's'hiri gI or sub-contracting isignature employ any parson persons subject to workman's comp ensa- certifies the fallowing: "I certify thaVin the performance of the work for which this permit is issued, I shall employ tion laws of California." 1`' t r The applicant call for eq 'red inspections. Complete drawing on reverse e. Date Title: 1 � Signed X I � FOR DEPARTMENT USE ONLY �. pate Area Application Accepted by Dai r it r Grout Inspection by Date Final Inspection by l eta p Additional Comments: [_] Manteca 823-71 D4 ❑ TaY Tracy 835-6385 ❑ Stk 466-6781 CI Lodi 369-3621 nvironmental Health Pes 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 9520 Applicant - Return all copies to: Eermit/Servic CK RECEIVED BY DATE PERMIT NO. FEE AMOUNT DUE AMOUNT REMITTED CASH INFO 3:� hta3 ..EH 13-24(REV.1/"sl �- EH 14-2e