FIELD DOCUMENTS FILE 1 - Laserfiche WebLink

Home Browse Search

APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SER IC�R ES ` �T}� ENVIRONMENTAL HEALTH DIVISION ' T " 445 N SAN JOAQUIN, PHONE (209) 469-34 A� D P 0 BOX 388, STOCKTON, CA 95201-0388 FAC # ;4 el o i l PERMIT EXPIRES 1 YEAR FROM DAM I ( Complete in Triplicate ) 111V93RD 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 compliance 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 721 Charter Way City Stockton Lot Size/Acreage 1 / 4 Acre Owner's Name Sungardens Address 721 Charter Way Phone463 - 0751 Contractor Pierson Drilling Add ress611 S . 9th St . , MOdestOLicense No . 614108 Phone 209 545 - 2 338 TYPE OF WELL/ PUMP: NEW WELL WELL REPLACEMENT 0 DESTRUCTION 0 Out of Service Well 0 PUMP INSTALLATION 0 SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well ❑ DISTANCE TO NEAREST : SEPTIC TANK SEWER LINES 10 1 DISPOSAL FLD . PROP . LINE 10 1 FOUNDATION AGRICULTURE WELL OTHER WELL 54 r PITS / SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial ❑ Open Bottom ❑ Manteca Die. of Well Excavation Dia. of Well Casing 211. N Domestic/ Private ❑ Gravel Pack ❑ Tracy Type of Casing —PVC Sch 40 Specifications I 'I Public ❑ Other Cl Delta Depth of Grout Seal 46 r Type of Grout Cement I I Irrigation _ Approx. Depth I I Eastern Surface Seal Installed by Pier s O n Drilling (� Repair Work Done 0 Type of Pump H . P. State Work Done Well Destruction ❑ Well Diameter Sealing Material i Depth Depth _ Filler Material i Depth TYPE OF SEPTIC WORK : NEW INSTALLATION i I REPAIR / ADDITION I I DESTRUCTION I I ( No septic system permitted if public sewer is available within 200 feel. ) Installation will serve: Residence Commercial _ Other Number of living units: _ Number of bedrooms Character of sod to a depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG . TREATMENT PLT . ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. 8 Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Founaahon Property Line `h IL SEEPAGE PITS 11 Depth Sire Number ,ter SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, stale 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 $hall not employ any person in such manner as to become subject to workman's 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 shell employ persons subject to workman's compensa- tion lave of California. " The applicant mus ac ll require tions. Complete drawin on reverse side. Signed / Title : President Date: 3 / 30 / 94 FOR DEPARTMENT USE ONLY Application Accepted by Date " Al Are Pit or Grout Inspection by Data Final Inspection by Dale Additional Comments: Applicant - Return all copies to : San Joaquin County Public Health Services Environmental Health Permit/Services 445 N. San Joaquin, P.O. Box 388, Stockton, CA 95201-0388 INFO AMOUNT DOE AMOUNT REMITTED CASH RECEIVED eV DATE PERMIT NO. EM 1324 IREV. I / x sl Yr / v�u �-: F�' ' �.) •� ` ' �'Vl / 'J iI � / a EH 14.m A`+ �/' �h..