91-0222 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT 4 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P O BOX 2009, STOCKTON, CA 95201 KA JOB v S. s (209) 468-3447 20-2983-05 'PPs32YTT EXPIRPSS I YEAR DAT,9 ISSUED i D (Complete in Triplicate) 0 Appl3cati to hereby made to Baa JoeqA 1unty for a permit to construct and/or install the work herein described. This application is made in cotsplitr.nce with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Josqula County Public Health Services. APN L48-100-09,26, 27 TRAINA ESTATES t Off Fairbanks Rd, North of Bates Rd. City Tracy Lot Size/Acreage Job Address Albert-Noble Company, Inc 35 East 10th Street,Tracy,CA gpho e Phone Name address t o bo • Contractor Spectrum/Kleinfelder 'Address2825 E. Myrtle Street License No. 512265- Phone 948-1345 TYPE OF WELL/PUMP. _NEW WELL ID WELL REPLACEMENT 0 DESTRUCTION Lr0=-Ur -�_ PUMP INSTALLATION ❑ SYSTEM REPAIR 0 OTHER ] 77 V I DISTANCE TO NEAREST; SEPTIC TANK SEWER LINES DISPOSAL FLD, f WT%fE5 6 Test Borings FOUNDATION AGRICULTURE WELL OTHER WELL falS 10r_15'. Def p Dia, INTENDED USE TYPE OF WELL i° PROBLEM AREA CONSTRUCTION SPECIFICATIONS No GW C7 Industrial ❑ Open Bottom ❑ Manteca is. of Well Excavation of ►t9 Type of Cavin � � s,- anticipate i U Domestic/Private ❑ Gravel Pack, = ❑ Tracy yP g If GW M Public CI Other " ❑ Delta Depth of Grout Seal Type Uf-aTcrur encountered will 0 Irrigation ^Approx. Depth ❑ Eastern Surface Soul Installed by backt-i-11 with Repair Work Done L3 Type of Pump; H.P. State Work Dore _ Hole Plug" Well Destruction ❑ Well Diameter Sealing Material i Depth Depth i Filler Material 4 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPAIRIADDITION L DESTRUCTION Cl INo septic system permitted if public sewer is j available within 200 feet.) 'I Installation will serve: Residence 6 Commercial-,._. Other Number of living units. Number of bedrooms Character of Boil to a depth of 3 feet: ' Water table depth SEPTIC TANK. 0 Type/Mfg Capacity No. Compartments ! PKG. TREATMENT PLT.❑ Method of Disposal �. Distance to nearest: Well Foundation Property Line q LEACHING LINE Cl No. b Length of lines Total length/size # FILTER BED (3 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I 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 i rules and regulations of the San Joaquin county 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: "I cenify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's eompensa, tion laws of California." i1 The applicant miust call for all r d inspgitions, Complete drawing on reverse side. Signed X Title: Engineering Geologist Date: 1-21-91 EPA ENT USE ONLY Application Accepted byF6FOR Date Area Pit or Grout Inspection by Date Final Inspection by Date 2 !' Additional Comments: - Applicant - Return all copies to. . SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES i ENVIRONMENTAL HEALTH DIVISION-PERMIT/SERVICES 445 N SAH JOAQUIN, P 0 BOR 2008, STOCKTON.- CA 85201 FEE AMOUNT DUE AMOUNT REMITTEDCASH RECEIVED BY DATE PEAMIT NO. ,NFO . EH t3•N 1W.ifMel P�o y M (I I EH ,1.16.