90-3195 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR PERMIT # SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA 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. 1862 for well/pump and the Rules 1 nd#25507012 RerJgula�o 1 2f the San Joaquin Local Health District. Parri Job Address 3010 W. Hwy 932 city Tra,,-y Lot Size PM Raul Rodriguez Address 1505 Franklin Ave. , Tracy Phone 835-3861 Owner's Name , Hennin s Bros. Address 3525 Pelandaie, Mad. License No. 290813_Phone 545-1185 Contractor REPLACEMENT El DESTRUCTION ❑ W WWELL ` TYPE OF WELL/PUMP: NEW OTHER ❑ PUMP INSTALLATION ❑ . SYSTEM REPAIR ❑ DISTANCE TO NEAREST: SEPTIC TANK none SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PR06LEM AREA CONSTRUCTION SPECIFICATIONS r� Dia. of W Q Industrial ❑ Open Bottom Casing ❑ Manteca Dia. of Well Excavation Specifications ❑ Domestic/Private [A Gravel Pack It Tracy Type of Casing PVC F] Delta Depth of Grout Seal 1 Type of Grout�n�na�— I, ❑ Public Ll Other dri 11 wr IX Irrigation --Approx. Depth l I Eastern Surface Seal Installed by ` Repair Work Done 0 Type of Pump H,P. State Work Done Well Destruction ❑ Well Diameter ` Sealing Material [top 501 Depth. z!5 Filler Material (Below 501 `� y TYPE OF SFPTIC WORK: NEW INSTALLATION IN'1 REPAIR/ADDITIOI I DESTRUCTION I I (No septic hin m permitted if public sewer is 1lDv t,t. Installation will server Residence Commercial_ Other ' Number of living units: Number of bedrooms �y4 5 V -'t.ti a"d,.,,_epttiof 3-feet: ' Water table depth Character of si)d ' " i I SEPTIC TANK ❑ Type/Mfg k 'r Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal I Distance to nearest: Well Foundation Property Line 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 ❑ Distance to nearest: Well Foundation Property Line Y 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 District. i 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 -contractemploy any person in such manner as signature to become subject to workman's compensation laws of California." Contractor's hiring to workmanlscompensa certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ p 1 tion laws of California." The applicant must call for all required inspections. Complete drawing on erse side. 12-4-90 Signed X Hennings Bros. By Title: Date: I /i��'"" FOR DEPAR NT USE ONLY ` J7- 7u Application Accepted by Date Area, Pit or Grout inspection by Date Final Inspection by Date Additional Comments: 4l 1 ❑ Lodi -3621 ❑ Manteca 823-7104 C Tracy 835-6385 ❑ St Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEECK RECEIVED BY DATE PERMIT�NO. ZAMOUNTDUEAMOUNT REMITTED CASH INFO+,EH 13-24{REV.i i a 5) EH 14-2e