FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICATION I { i SAN JOAQUIN COUNTY PUBLIC HEALTH' SERVI ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468--342 P O BOX 2009, STOCKTON, fCA 55201 SEP 2 11994 PERMIT EXPIRES 1 YEAR FROMIDATE ISSUED Note: For 3 monitoring (Complete in Tripli6ate) t VIRONMENTALHEALTH wells with identical. specifications. 1 PERMIT/SECES Application is hereby made to San Joaquin County for a permit to constructiRVI and/6r,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. Ii rI I a8e Lot Size/Acre Job Address 1201 N. Pershing AVpn17P_ _ City$ G]�t _. ,tpp� go T Owner's NameCitV Of Stockton Address 422, N F.1 T)nradn ;1StrPPt Phone 209-937-8411 4230 Kiernan Ave. ',' No� 105 ContractorThe Twining Labs address - C Aq5. 56 License NoC575061 59 Phony - - 0 TYPE OF WELL/PUMP: NEW WELD WELL REPLACEMENT P1 g DESTRUCTION 0 Out of Service Well ❑ PUMP INSTALLATION ❑. SYSTEM REPAIR 3 OTHER ❑ Monitoring well} DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES 1-50 . DiSPOSAL FLD.NA,__— PROP. LINE J_DQ_' W FOUNDATION <2_0 AGRICULTUREWELL>2nna OTHER WELL->`_Q_Q_L PITS/SUMPSN&__ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation$_ij n Dia. of Well Casing - ' t f7 Domestic/Private k3}Gravel Pack ❑ Tracy Type of Casing IiQdullo 40 TWC!Specifications 2-inch PVC V1 Public 1-1 Other IN Delta Depth of Grout Seal 11 $ r :a Type of Grout enonl eall I I Irrigation 4_02Approx. Depth I I Eastern Surface Sedl Installed by. Twining Repair Work Done L3 Type of Pump NIA H.P. NIA _ State:Work Done Installing Monitori g Well Destruction ❑ Well Diameter 2-inch Sealing Material 6 DepthBe11�612it well,5r Depth4ll p"rllsT� t 8 Epet Filler Material & Depth r t( 2-15 1 r TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDITION ( I DESTRUCTION I 1 ,'lNo septic system permitted if public sewer Is 'available within 200 feet.) 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 I+ No. Compartments 4 PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line I+ LEACHING LINE CI No. & Length of lines j;Totai length/size FILTER BED n Distance to nearest: Well Founoation lit Property Line {� SEEPAGE PITS It Depth Size � Numbsr SUMPS Ll Distance to nearest: Well foundation Property Line DISPOSAL PONDS ❑ s 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 county j Home owner or licensed agent's signature"certifies the following: "I certify that in the parlormance oft the work for which this permit is issued, I shalt not ! employ any person in such manner as to become subject to workman's compensation taws 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." li The applicant must call for all required inspections. Complete drawing on reverse side. Signed X Title: Date: • r PARTMENT USE ONLY PI I` Application Accepted by _ ,Date Area Pit or Grout Inspection by Date Final Inspecti n by `rh Date Additional Comments: Wok K WVa r t [Cgi/Y 1 l ikal(,l.(.(,{ Applicant - Return all copies to: San Joaquin County Public HealthiServices Environmental Health Permit/Services P 445 N San Joaquin, P O Box 2009,i�Stkn„jCA 95201 P ,1 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY . DATE �P'E�Rr Mw< II'NO. EH 1324(REV,i/nSI -/i[EH t29 1 02 • Ila ��