89-257 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAs. HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone {209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 7 J (Complete in Triplicate) ��✓ 7�'} Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install/ an rk hereiY(dp ibed. T plication is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and t `rand Regu ri ns of San Joaquin VI Local Health District. W. 4th Street SE Corner � Job Address City Ripon Lot Size y PM 1 95366 Owner's Name City of Ripon Address 311 W. 1st. Street, Ripon, CA Phone(209)59 -2108 Layne Environmental , 6u!8 Va%iey .Blvd. Contractor " z ' Address *roritatia, CA 9.2335 "_ License No. 45Z'609> Phone;355=3355` TYPE OF WELL/PUMP: NEW WELL ELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 750 SEWER LINES >50' DISPOSAL FLO. NA PROP, LINE NA FOUNDATION 7�— AGRICULTURE WELL NA OTHER WELL ';� 200' PITS/SUMPS ISA i INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation —inc Dia. of Well Casing 4-inch { i * Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing PVC Specifications i 1 Public40 r& ` 26r Monitorix}-g pelta Depth of Grout Seal 2a' & 90 t Type of Grout Cement/Bent I I Irrigation _.-Approx. Depth I I Eastern Surface Seal Installed by Pitcher Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material [top 501 I Depth Filler Material lBelow 501 ,1 TYPE OF SEPTIC WORK: NEW INSTALLATION I1 REPAIR/ADDITION [ I DESTRUCTION l I (No septic system permitted if public sewer is I available within 200 feet) Installation will serve: Residence_ Commercial_ Other i 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 y PKG. TREATMENT PLT, ❑ Method of Disposal VY J Distance to nearest: Well Foundation Property Line YYYY I+ LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ 'Distance to nearest: Well Foundation Property Line SEEPAGE PITS I 1 Depth Size Number SUMPS U 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 rules and regulations of the San Joaquin Local Health Di§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: "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 mu call for all required inspections. Complete drawing on reverse side. Signed X Title: Plant Manager Date: 7L ' Z$"A�K, FOR TMENT USE ONLY Application Accepted by Date r Pit or Grout Inspection by / P,ate Final Inspection by Date Additional Comments: y ❑ Stk 466-6781 ❑ Lodi 369-3621 ID Manteca 823-7104 ❑ Tracy 835-6385 I Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTE INFO D RECEIVED BY DATE PERMIT NO. ♦.EH 13-24(REV.t i n 5) 2J1 - �� ' EH 14-28. V i _ 7 vCJ 1 Applicant is Nestle..._Foods Corp. , Owner is Citv of Ripon. Aizreement is attached.