WORK PLANS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This applica is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Ryles and Regulations of the San Joaquin Local Health District. t1 f �l ( Job Address �S �Q'S 5;e_1 �'� 11�Q" City G Cd Lot Size PM " goo e Le_+r*_►.. IZ wA `- Owner's Name 0 Q v 'co • Address VZ-Z1 E- ih.q, 's C` A��aQQ%a-Phone � Tn/ Contractor r e Ol 0r/�J,b r., Address 1 10IS AV,,01 , VYr h+eZ�cense No. Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation s h t Dia. of Well Casing 7 Domestic/Private; �1❑l�Gravel Pack ❑ Tracy Type of CasingP_yC- Specifications, ]7 R,7.4 ../��` Onf��rjll O,tf)er ❑ Delta Depth of Grout Seal Type of Grout ❑ Irrigatiofi C�S fYJ/f �r! ACY gprax. Depth ❑ Eastern Surface Seal Installed by ' els^ Repair Work Done ❑ Type of Pump H.P. State Work.Done Well Destruction ❑ Well Diameter Sealing Material {top 501 Depth Filler Material (Below,501 TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑. (No septic system permitted it public sewer is available within 200 feet.l Installation will serve: Residence— Commercial_ Other s` Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Watei table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal a Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS ❑ Depth Sire Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 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 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'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 shall employ persons subject to workman's compensa- tion laws of California." The applicant t call for all required inspec ' ns. Complete drawing on reverse side, r/ Signed Title: _ fyldo'Y�1 Date: 3 Z x•S FOR DEPARTMENT USE ONLY y Application Accepted by �------- Date `>�f` Area 6T1 e Pit or Grout Inspection by Date Final Inspection by �y Date S Additional Comme ��!r'/y —�—� ✓ t/`"� '.le, �a Z`�' �l Stk 466-6781 ❑ Lodi 369-3621Q` 1] Manteca a23-7104 13Tracy 835-6385 WSJ'�'� Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2909, Stk., CA 95261 FEE AMOUNT DUE AMOUNT REMITTED CAA RECEIVED BY DATE PERMIT NO. INFO tH13-24(REV_ �-� �+� 3�5i$� iH 1426