Laserfiche WebLink
APPLICATION <br /> SAN JOAQ N COUNTY PUBLIC HEALTH. SERVICES � CElVEp <br /> SR #-71-..- 4 .,_ ; <br /> RONMENTAL HEALTH DIVISION <br /> AID # 3!445 N `S 'JOAQUIN, PHONE (209)46$-3420 ..e.Q ,l(j.tr�:r1JJ,7"e <br /> O% 2009, STOCKTON, CA 9.5201 . 7REppWFLL& <br /> FAC # IRIS 1 YEAR FROM DATE ISSUID RflLLfl <br /> LINV # Complete in Triplicate) <br /> Application ty for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules a>zd Regulations of San <br /> Joaquin County Public Health Services. <br /> Job Address 4110 Industrial Way . 11 City q'� Lot Size/Acreage t. <br /> Owner's Name McKesson Dru Co. Address One Post St. , Ste. 2850 - Phone 415 983-7598 w <br /> - San Francisco, CA 94104 <br /> Contraclor Greq_qDri.11in Address42-Berry Dr, , J?aeheco License No. 4897 Fi5 Phone g�2 <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ out of Service Well ❑ <br /> PUMP INSTALLATION C1SYSTEM REPAIR ❑ OTHER C3Monitoring Well <br /> T 'NCE TO'NEAREST: SEi'T!C TANK' SEWER LINE5 DISPOSAL FLq. PROP" LINE <br /> n DIS A <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> N IndustriatMonitorin Open Bottom ❑ Manteca Die. of Well Excavation Dia. i f Well Casing <br /> Ze r <br /> PVC schedule 40 <br /> fa Domestic/Private 0 Gravel Pack X] Tracy Type of Casing_ Specifications <br /> Il Public IN Othe,SandPack n Delta Depth of Grout Seal feet Type of ,,r —me <br /> I I Irrigation 20-25.'Approx. Depth I I Eastern Surface Seal Installed by GreggDrilling <br /> I Repair Work Done 0 Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material Depth <br /> Depth Filler Material Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 13 REPAIR/ADDITION I I DESTRUCTION I 1 INo septic system permitted if public sewer is <br /> available,within 200 feet.) <br /> i Installation will serve: Residence— Commercial_ Other - <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK, 0 Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT, 0 i L Method of Disposal <br /> 11 Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE Cl No. 8 Length of lines Total length/size <br /> FILTER BED n Distance to nearest: Well Foundation Property Line <br /> i <br /> I <br /> SUMPS SEEPAGE PITS Ll D sil ponte to nearest:. Welth l Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> 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 <br /> rules and regulations of the San Joaquin County <br /> 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 <br /> employ any person in such manner as to become subject to workman's compensation laws of California.- Contractor's hiring or sub-contracting signature <br /> 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- <br /> tion laws .1lh <br /> The ap cant must c I for squired inspections. Complete drawing on reverse side. <br /> Signed Title: Manager of Corporate Environ_.D 3 <br /> �F��PnI 'FF� Affairs Y <br /> R DEPARTMENT USE ONLY <br /> Application Accepted by Date res <br /> Pit or Grout Inspection by Date Final Inspection by f <br /> Additional Comments: <br /> Applicant - Return all copies to: San Joaquin County Public Health Services '073,/7;61/ <br /> Environmental Health Permit/Services <br /> 445 N-;San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> . i <br /> FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED By DATE PERMIT NO. <br /> INFO <br /> • EMl3741REV.r/nSl , <br /> Err 14.7e <br />