93-0693 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

'1 APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES � ENVIRONMENTAL HEALTH DIVISION � 445 N SAN JOAQUIN, PHONE (209)468-3420 , 11 P O BOX 2009, STOCKTON, CA 95201 Y FROM DATE S � PERMIT EXPIRES (Complete in Triplicate) d' Application is hereby made to San Joaquin County 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. �� , /' CGAA' WI City D Lot S Sze/Acreage Job Address r! !! aeZ Address �9`�/ 4t, n' 'v ""j�Z Phone ° Owner's Name �l Addrest�U Contractor �N d Sn 7 's d� Ot-V � W'7 /� �"P' License No. 7.7Phone Service Well 0 TYPE Of WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION LI out Of Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR 11DTHER G1 - _DISTANCE TO NEAREST: SEPTIC TANK I SEWER LINES I DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER-WELL : PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS, +N LI Industrial ❑ Open Bottom `❑ Manteca Dia. of Well Excavation _:Dia. of Well Casing Casin ` `' Cl pomeaticlPrivate C1 Gravel Pack ❑ Tracy Type of 9- `��` Specifications i'1 Public fa Other i1 Delta Depth of Grout Seal Type of Grout_ - I I Irrigation ,,,,_.Approx. Depth I I Eastern Surface Seal Installed by } Repair Work Done L7 Type of Pump I H.P. r —,State Work Done— Sealing.tfaterial i Depth. 4 Well Destruction ❑ Well Diameter } e_ Depth r ---Filler llateriai i Depth y TYPE OF SEPTIC WORK: NEW INSTALLATIONX REPAIR IAODITION.I;P.DESTRUCTION I 1 INo septic system permitted if public sewer is i ivailable within 200 feet.) Installation will serve: Residence-L:-- .!Commercial_ Other.- Number of living units:'�! _ Number of bedrooms Y Character of soil to a depth of 3 feet: I cf "' Water table depth 0 SEPTIC TANK IN Type/Mfg "Em C:A!yr G _+ - Capacity � No. Compartments PKG. TREATMENT PLT.0 i Method of Disposal Distance to nearest: Well I 00 !!—_Foundation j p Property Line 897" Total length/size 320 LEACHING LINE P1 No. S Length of lines , FILTER BED n Distance to nearest: Well /Co'' - Foundation 0_ Pi operty Lina f l � SEEPAGE PITS I I Depth r Size Number SUMPS Ll Distance to nearest: —Will" ' Foundation Property Line DISPOSAL PONDS ❑ 1 Thereby 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: 111 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 canifies 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." i The applicant mus call for all required inspections. Complete drawing on reverse side. Signed x 311 - -—Titles-- --- •-...— ._...� — Date: FOR PART ENT USE ONLY Application Accepted by Date Ara Y� �' a + Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: t Applicant - Retuzn all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San.Joaquin, P 0 Box 2009, Stkn, CA 95201 E�AMMDUNT DUE AMOUNT REMITTED SkRECEIVED BY DATE PERMIVNO.