FIELD DOCUMENTS FILE 1 - Laserfiche WebLink

Home Browse Search

� i APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIONAL 445 N SAN JOAQUIN, PHONE (209) 469-3420 0 ^ P O BOX 388, STOCKTON, CA 95201 -0388 f ` • � PERMIT EXPIRES 1 YEAR FROM DATE ISSUED SAfJ ,I(t � ll „ ( Complete in Triplicate ) �( 113f1t, :.jr Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in ccMdliadcb. With San'� / Joaquin County Development Title Section 9-1110.3 and Section 9-1115.3 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address -A 727 E . Charter Way , S ocktDn . Cnv 1.ot Sipe/Acreage 1 / 4 Acres owneh Name Sun Gardens Address 721 E . Charter Way Phone 463 - 0751 III . Contractor VBI Inc . Address2101 Webster St . OaklaLWnse No. 682990 Phone TYPE OF WELL/ PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well Cl I�I Hydropunch Wel -PUMP INSTALLATtON O SYSTEM REPAIR ❑ OTHEFIND Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES 70 If t . DISPOSAL FLD. PROP , LINE FOUNDATION AGRICULTURE WELL OTHER WELL / PITS/SUMPS j INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial Cl Open Bottom ❑ Manteca Dia . of Well Excavation Dia. of Well Casing 0 L.I Domestic/ Private ❑ Gravel Pack ❑ Tracy Type of Casing _ 0 Specifications PI Public (-I other fI Delta Depth of Grout Seal 50 f t . Type of Grout Cement 11 Irrigation _ Approx . Depth It Eastern Surface Seal Installed by VBI , Inc . Repair Work Done ❑ Type of Pump H . P. __ State Work Done _ Well Destruction V Well Diameter Sealing Material L Depth Cement — SOFt . Depth _ Filler Material L Depth - TYPE OF SEPTIC WORK : NEW INSTALLATION I I REPAIR /ADDITION I I DESTRUCTION I I INo septic system permitted it public sewer is available within 200 feel. ) Installation will serve: Residence _ Commercial _ Other Number of living units: _ Number of bedrooms Character of and to a depth of 3 feet: Water table depth SEPTIC TANK 13 Type/ Mfg Capacity No. Compartments PKG. TREATMENT PLT , D Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 8 Length of lines Total length/size FILTER BED n Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, slate laws, and rules and regulations of the San Joaquin County 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 shell not employ any person in such manner as to become subject to workman's compensation laws of California , " Conlreclor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shell employ persons subject to workman's compensa- tion laws of California." The applicant must c 8 lot all r tired inspections. Complete drawing on reverse side. Signed Tide: President Date: 5 / 15 / 95 FOR DEPARTMENT USE ONLY Cy c Application Accepted by Date S L � Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant - Return all copies to : San Joaquin County Public Health Services Environmental Health Permit/Services /1 445 N. San Joaquin, P.O. Bo 388, Stockton, CA 95201-0388 3,S Ul a a FEE INFO AMOUNT DUE AMOUNT REMITTED H� ORECEIVED BY DATE PERMIT� N . /CATS/ EN 13-74 (REV. I r x 510 �� n, FN 14 7a - _/