89-2377 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT ti SAN JOAQUIN LOCAL HEALTH DISTRICT J 1601 E. HAZEL i ON AVE., STOCKTON, CA Telephone (209) 466-6781 MAX PERMIT EXPIRES 1 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 described. This application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No, 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District, Job Address 30.11 Benjamin Halt Drive City Stockton Lot Size PM P.O. Box 4023 Owner's Name Shell Oil Company Address Concord, CA 94524 • _ Phone (415) 451--2799 Contractor Spectrum Drilling Address2825 E. Myrtle StocktonLicense No. 512268 Phane465—$712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION LX PUMP INSTALLATION ❑ SYSTEM.REPAIR ❑ OTHER ❑ f DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 11 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 12 Dia. of Well Casing 411 Q Domestic/Private k-1 Gravel Pack ❑ Tracy Type of Casing_ PVC Specifications I'1 Public Cl Other Cl Delta Depth of Grout Seal 51 Type of Grout ,4ment/Bent nite? I I Itrigation 2-6.'Approx. Depth I I Eastern Surface Seal Installed by Trace Environmental Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction 6d Well Diameter Sealing Material (top 501 (4) Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I ) REPAIR/ADDITION l I DESTRUCTION I I (No septic system permitted it public sewer is 11 available within 200 fact.) 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 LEACHING LINE ❑ No..R Length of lines + 1 Total length/size J FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS i I Depth Size Number SUMPS L1 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS F) # 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 Ds%trict. 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: "1 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 ust call for all required inspections. Complete drawing on reverse side. Signed Harr Marcu!Title- - Project Geologist pate_ August 14, 1989 FO ARTMENT USE ONLY ' Application Accepted by Date .Area Pit or rout nspection by c ate Final Inspection by Date Additional Comments: i ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Man! 623-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY 111 INFO DATE PERMIT•NO. +-9H 12.2/(REV.I r x ss Cl