84-162 - Laserfiche WebLink

Home Browse Search

Application.is he descri bed.'' -.This and the Rules and Job Address Owner's Name d`r Contractor's Name APPLICATION FOR PERMIT SAN JOAQUIN'LOCAL HEALTH,DISTRICT 1601 E. H i- LTON,AVE., STOCKTON, CA. Tel ephohe:(209)-466-6781 PERMIT EXPIRES`i YEAR'FROM DATE ISSUED (Co 1 t ' T • l' PERMIT NO. DATE ISSUED�lh-'9 TYPE OF WELL/PUMP WORK: NEW WELL Ff� WELL REPLACEMENT DESTRUCTION -F-1 PUMP INSTALLATION [ SYSTEM REPAIR OTHER DISTANCE TO NEAREST: SEPTIC TANK ZOg!�41 SEWER LINES D r DISPOSAL FLD-`# PROP. LINE �� f k *� FOUNDATION % it -AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS "•.` Industrial Ef Open Bottom Manteca Dia. of Well Excavation Domestic/Private C51derlavel Pack ❑ Tracy Dia. of Well Casing ublic G Other,r - Delta tType.of Casing_._ .0 Irrigations ,. Approx. ❑ n Easter„ 5 ecifications r_1 Cathodic Prote ton , - � Oepth P F Depth of Grout Seal Geophysical l�(J U Other, / y Type of Grout�by. it "�i�. t' S (face Seal installed Repair Work Done Type�� Pump em �� H.P. lr / YDS` t to Work Gone '' 32 Repair i a Well Destruction,Ei Well Diameter Sealing Material (top 501) �• Depth, Z Filler Material'(Below 501) ' ) TYPE OF SEPTIC WORK: NEW, INSTALLATiON U REPAIR/ADDITIQN „U "(No�septic„tank,.orseepage pit permitted if public sewer is o ` I available within 200 feet.) Installation will serve: Residence [Commercial Other € i Z §'Number of living units. mp e e in rip cate) 1 Lot size made .to the San Joaquin Local Health District fora permit to construct and/or install the work herein. ication is made in compliance with 'San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump yI do f e' oaquin�oocyal ea th District. / ` -, * -' Methodof Disposal EWAGE SYSTEM t Cl Subdivision Name Foundation PropertyLineDESTRUCTION �. Address + ,,Z1 �, E - Phone 'No. -'&-Length of lines License No. eA1 _ FILTER BED " -Phone Foundation Property Lane TYPE OF WELL/PUMP WORK: NEW WELL Ff� WELL REPLACEMENT DESTRUCTION -F-1 PUMP INSTALLATION [ SYSTEM REPAIR OTHER DISTANCE TO NEAREST: SEPTIC TANK ZOg!�41 SEWER LINES D r DISPOSAL FLD-`# PROP. LINE �� f k *� FOUNDATION % it -AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS "•.` Industrial Ef Open Bottom Manteca Dia. of Well Excavation Domestic/Private C51derlavel Pack ❑ Tracy Dia. of Well Casing ublic G Other,r - Delta tType.of Casing_._ .0 Irrigations ,. Approx. ❑ n Easter„ 5 ecifications r_1 Cathodic Prote ton , - � Oepth P F Depth of Grout Seal Geophysical l�(J U Other, / y Type of Grout�by. it "�i�. t' S (face Seal installed Repair Work Done Type�� Pump em �� H.P. lr / YDS` t to Work Gone '' 32 Repair i a Well Destruction,Ei Well Diameter Sealing Material (top 501) �• Depth, Z Filler Material'(Below 501) ' ) TYPE OF SEPTIC WORK: NEW, INSTALLATiON U REPAIR/ADDITIQN „U "(No�septic„tank,.orseepage pit permitted if public sewer is o ` I available within 200 feet.) Installation will serve: Residence [Commercial Other € i Z §'Number of living units. - Number of bedrooms 1 Lot size .Character of soil to ai depth'_of 31feet:_' Water table depth SEPTIC TANK l Type/Mfg a Capacity No. Compartments PKG. TREATMENT PLT. [] :Type/Mfg 1 Capacity * -' Methodof Disposal EWAGE SYSTEM t Cl .Distance to nearest: Well Foundation PropertyLineDESTRUCTION .I /-- LEACHING LINE LINE ❑ 'No. -'&-Length of lines Total lengfgsize 1r, s. FILTER BED " Distance f_nearest: Well Foundation Property Lane E PITS ❑ d u� t AL PONDS D 1 Depth . V Size i/ Distance to -nearest: Well Foundation Number Line I hereby certify that I,have prepared this application and that thhework will be done in accordance'with San Joaquin county ordinances, state laws,"And rules and regulations of the San Joaquin_Local Health District. 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§ 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 empioyrpefsons-su ject to workman's compensation laws of California." The applicant must call or 1l,requi"ed inspections. Complete drawing on reverse side. yJ gned X - le: _� '` — Date: Ili jJ b F DEP TMENT USE ONLY 7 Application Accep by AreaE3 Stk 466-6781 Additio ents: ! G_Lodi 369-3621 Pityr Grout I pection by Date 3 - 11 j] Manteca 823-7104 Final pection by _ `. _ Date�7 6 „ LJ Tracy 835-6385 Applicant - Return all copies to; r mental. Health Permit/Services-1601 E. Hazelton ve., P.O. Box 2009, Stk., CA 95201 FEE INFO BASE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. EH 13-24 REV. 10/82 10/82 500 iN, 14-26 5