87-4230 - Laserfiche WebLink

Home Browse Search

>n' APPLICATION.FOR PERMIT � p SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E. HAZEL T ON AVE., STOCKTON, CA r_ Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED pp (Coi>nplete in:Triplicate): � N D- Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein describ . This a plication is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump andtheRules and Regulations of the San Joaquin Local Health District. " oi i 626 1628 1630 `.�.. ...�r Job Address 1632 al'ld 1634' Newport r f City Stockton Lot Size 4PM Owner's Name AnthonyGi lia ' " Address 1836 Sutro" Y' phone 464-8040 Contractor Williams Plumbing Co Address 2360 N. Wilson Way License No. 289293 Phone 46674004 ' t TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINESDISPOSAL FLD. PROP..LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS EJ Industrial ❑ Open Bottom ❑ Manteca Dia:of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications f ❑ Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout � j ❑ Irrigation ---Approx. Depth ❑ Eastern Surface.Seal Installed by F' Repair Work Done ❑ Type of Pump H.P. State Work Done Y v NWell Destruction ❑ fi Well Diameter Sealing Material {top 50'► Depth, Filler Material (Below 501 I TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTIO (No septic system permitted if public sewer is . available within 200 feet.► W t Installation will serve. Residence Commercial - Other s C z 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 y�y Distance to nearest: Wel Foundation Property Line ti LEACHING LINE ❑ No- & Length of Innes Total length/size I FILTER BED ❑ Distance to nearest: ; Well Foundation Property Line kx) SEEPAGE PITS k ❑ Depth r r Size Number SUMPS 01�6istance to nearest: r Well Foundation' Property Line . DISPOSAL PONDS e ❑' ,� 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 Local Health District.. } I 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 m rpt call for all r eI inspections. Complete drawing on reverse side. r' Signed X 7Title: Date: I1-3 4'V7 i {, FO ARTMENT USE ONLY Application Accepted by 1�t Date _ ."/3"V- Area r Pit or Grout Inspection by Date Final Inspection by w Date`Z 7�� Additional Comments: s' I � ❑ Stk 466-6781 ❑ Lodi -3621 b Manteca 823-7104 ❑-Tracy; 835-6385 Applicant- Return all copies to; Environmental Health Permit/Services 1601 E. Hazelton AVe.,1P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CASH nr:,' M CK 011 t INFO RECEIVED BY DATE PERMIT'NO. 4 ♦ EH 11/ �..• EH 3-24(REV. H5}1428 i