86-110 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT j SAN JOAQUIN, LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone 12091 466-6781 t PERMIT EXPIRES,I YEAR FROM DATE ISSUED (Complete'in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein-desdribed. This application is f made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the R41es and Regulations of the San Joaquin -Local Health District. Job Addressi L`rH 0 I T .RD C,ty`S TO C K T O N Lot sze " '' ' PM Owners Name MA RCH I N I .�A•RMS Address- 9000 .W.. HOWARD RD., stockton. 'Phone -463-9790 ContractorMENN NGS' BROS-1 Address 3525 PELANDALE AVELicense No.290813 Phone 545- 1 185 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT DESTRUCTION ❑ € PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK O�� SEWER LINES ��°t DISPOSAL FLD. PROP. LINE _ L FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS r—•.` INTENDED USE TYPE OF WELL- PROBLEM AREA CONSTRUCTION SPECIFICATIONS k L1Industrial LI Open Bottom ❑ Manteca Dia. of Well Excavation - i' Dia. of Well Casing 811 (X Domestic/Private �,Gravel Pack ❑ Tracy Type of Casing PVC Specifications ❑ Public CI Other ;. El Delta Depth of Grout Seal 50.1 Type of Grout BENTONITE ❑ Irrigation �4pprox.''.Depth ❑ Eastern Surface Seal Installed by H E N N I N G S BROS. D R I L L I N G Repair Work Done'.,, Type of Pump H.P. State Work Done Well Destruction 'x ❑ Well-Diameter Sealing Material (top 501 ' :•Depth I Filler Material (Below 501 TYPE OF SEPTIC WORK:: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is available within 200 feet.] Installation will server Residence Commercial_ Other . '� Number of living units Number of bedrooms C �( Character of soil to,a depth of.3 feet:• Water table depth �:-h t , s . : SEPTIC TANK ❑' 'Type/Mfgil Capacity No. Compartments PKG. TREATMENT PE,T ❑ j f K 1. 11 Method.of disposal I— I4 %. to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED t ❑ Distance t; nearest: Well Foundation Property Line SEEPAGE PITS ❑ Depth Size Number i SUMPS t ❑ Distance to nearest: Well Foundation Property"Line DISPOSAL PONDS ❑` I / I hereby certify that I have prepared this application and that the work will be done in accordance with�San Joaquin county ordinances,stale law's, and rules and regulations of the San Joaquin.Local Health District. 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 applicant must call for all required inspections. Complete drawing on reverse side. Signed X AJ&, ,Title: Date: FEB. 1 1 , 1986 IFOR DEPARTMENT USE ONLY Application Accepted by �' Date 1 �/ Area X8' { Pit or Grout Inspection by Date Final)nspection b Date Additional Comments: ` '' l A, ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 El Tracy 8355-6385 r Applicant eturn all copies to:.Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 y FEE INFO �A/MOUNT,DUE.r'),.. AMOUNT REMITTED CASH RECEIVED By DATE — PERMIT'N0. 1 + 14.2e/REV.i/s 51 EH / C{ t Q�; �/�f ._ 1 CC "'__ w_ 5-a... ./ - a. .. ✓✓ �` _ -.- w`.. .. - _ .f� S i.IV