90-1224 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA 3Ju" Telephone (209) 466-6781 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. 11362 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 32150 S. Bevis Rd. city Tracer Lot Size 250'x5221 PM Owner's Name Michael M. Pett Address 2630 W_ Urham Ferry, TraCyr Phone836=4A2B Contractor Hennings Bros. Address 3525 Pelandale, Mod. License No.290813 Phone 545-11 AS TYPE OF WELL/PUMP: NEW WELL EX WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 100' SEWER LINES DISPOSAL FLD. 100'+ PROP. LINE FOUNDATION .-- -AGRICULTURE WELL OTHER WELL----- v� PITS/SUMPS-=-----"-- .- -� r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS El Industrial ❑ Open Bottom 1-1 Manteca Dia. of Well Excavation Dia. of Well Casing 6 FX Domestic/Private I Gravel Pack X Tracy Type of Casing PVC Specifications 1"1 Public fl Other n Delta Depth of Grout Seal 100 Type of Grout_Bent A _. I I Irrigation — Approx. Depth I I Eastern Surface Seal Installed by dri 1 l er Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 50') i Depth Filler Material (Below 501 _ TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIRlADDITION I I DESTRUCTION f I (No septic system permitted if public sewer is N available within 200 feet.) y Installation will serve: Residence_ Commercial_ Other '' 1' V% Number of living units: Number of bedrooms Character of sail to a depth of 3 feet: Water table depth t SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal ' Distance to nearest: Well Foundation Property Line LEACHING LINE Ll No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS i I Depth Size _ Number SUMPS ❑ Distance to nearest: Well Foundation Property Line .. _ rt_r .DISPOSAL PONDS .❑ �� .�- • - :� - *a- 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 DPltrict. 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 drawin reverse side, Signed x Hennings Bros. Tit Date: 5-16-90 F D RTMENT USE ONLY Application Accepted byDate Area Pit or Grout Inspection by / Date Final Inspection by Date 7 O Additional Comments: eq,1-4 'i-�_L�J ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6985 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 t 1 CK FEE AMOUNT DUE AMOUNT REMITTED _ RECEIVED BY DATE PERMIT NO. l INFO CA +.EW 14-2e 1ttE'V 1 H sl C] S �! �"r�� I O C)-ila-