93-980 - Laserfiche WebLink

Home Browse Search

APPL•I C_+1 T Y ON SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)46$-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 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. Job Address DDRW-Trac , 25600 .Chris''mdn'Rd city Tracy Lot Size/Acreage 448-acre . Owner's Name Defense Logistics AgencyAddrees TDDRW-Sharpe, Roth RdMarshall Cloud .L`athl'o CA 95330 -p-� .-.._ Phone (209)982-2086 1202 E. Kentucky Avenue Contractor_Water Development Address Woodland, CA License No.C57L5537,1P Phone (916)662-28 9 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of service Well ❑ PUMP INSTALLATION-❑ SYSTEM REPAIR C7 OTHER ❑ 4 Monitoring Well 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 SPECiFICATiON5 , n Industrial ❑ Open Bottom ❑ Manteca Dia.,,of Well Excavation 10 in i Dia. of Well Casini 4 in Il Domestic/Private IR:Gravel Pack ❑XTfacy Type of Casing_ sch 40pvc Specifications Il Public Cl Other ❑ Delta Depth of Grout Seal - 115 ' T Portland II Type'-of Grout I I Irrigation `Approx..Depth I I Eastern Suiface.Seal installed by „Aevelonment Repair Work Hone U Type of Pump H.P.,, State Work Done_ Well Destruction ❑ Welf•Diameter Sealing Material & Depth k Depth ' Filler Material lir Depth d TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/AODITION 1 I. DESTRUCTION 111No septic system permitted if public sewer is available within 200 lest.) 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.C1 ` Method of Disposal Distance to nearest: Well Foundation Property Lina r LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest7, Wall FoundationProperty Line 'I r SEEPAGE PITS 11 Depth Size Number SUMPS Li Distance to nearest: Well Foundation Pro DISPOSAL PONDS ❑ t�ertY Line r I hereby certify that 1 have prepared this application and that the work will be done in'accor`dance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County r 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 ri(it employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or subcontracting signature ws of California."-the following: "1 certify that in the performance of the work for which tiCertifiesl on lathis permit is issued, I shall employ persons subject to workman's compensa- ti - The applicant must cal ctions. Complele drawing on reverse side. Signed Title: Project Manager 5/20/93 j • • . - Dare: 1 FOR DEPARTMENT USE ONLY Application Accepted by t Date � 3 .�- _ Area Pit or Grout lnapection by Date Final Inspection by Date Additional Comments.- Applicant omments:Applicant - Return all copies to: San Joaquin County Public Health Services pC(� Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK INFO n CASH RECEIVED BY DATE PERMIT NO. ' EM 13-24 IREV.1 M 51 EN 13.24 '. �� v 15 93 MoD