FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

.AN .;jAQUIN i:OUNTY -t'SLIC :=VICES � IVIRONMENT.sL ALTS DIVISION ;45 it ,;AN .;OAQUIN . :'HONE D09)468-3420 O BOX 2009 . -TOCKTON , -'A 95201 DERSIIT =IRES 'EAR FROM DATE ISSUED •pplication is neretry made to San Joaquin Ccunty ror a hermit is construct and/or install the vorx nerein described. This apiicatiea ie made is c®ilance vi-n San Juaquin ";inty vrvaance ho. -.-, and 1862 and the Rules and Regulations of San ::ufuin County W--blic Health Services. 25900 South ChoYman Pd 908 ,Jb Address 1 .;.Iv --LSize/Acreage DPRww Sharpy F--h Marshall 1710114 � nSe l oyfsllcsi}yrncr l athr0 Cue 3 0 hone (20)g82-20fb , wnef s Name =ddress /b �d,IX 1326 Z750wnty dad 9P 8onuattor Layne. W'tstem Gm n Address Lid land 17/4 `Pff15 _iCense No. 51 O-D /1 Phone "1q 1/^) TYPE OF WELL/PUMP NEW WELL :1 NELL REPLACEMENT "' DESTRUCTION Out of Se"IeS Well PUMP INSTALLATION G SYSTEM REPAIR L7. OTHER C Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS v TENCED USE TYPE OF WELL PROBLEM AREA -ONSTRUCTION SPECIFICAT_IQNS { - .odustnal = Open Bottom _. Manteca -,a. of Well Escava/1ton Dia. of Well Casing • r 1n Comestdc/Private Graved Pack ,{Tracy -,pe of Castnq_ Ub e 'wQ ! mG1"`5penncanons Pvbhc Other 7 Delta Depth Of Grout Seal an nawq Type of Grout xtmgauon _Approx. Depth Eastern Surface Soul Installed by Repair Work Done _ Type of Pumo H.P. rc to Vj�prly�Done Well Destruction 7 Well Diameter 1n Sealing Material L Depth C./ � 1'/ f'T/ZI7J/� Depth (00V� Filler Material L Depth class H panYuX 0 ]P TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I : DESTRUCTION I Wo septic system permitted it public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number of living units: _ Number of bedrooms Character of soli to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE L:! No. 8 Lengtn of lines Total lengin/size FILTER BED J Distance to nearest: :Alen . curdatwr. Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest. well Foundation Property Line DISPOSAL PONOS 7 1 hereby cRMy 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 Home owner or licensed agents signature canities the following: "I certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's Miring or su Pcontractmg signature certifies the following: "I candy that in trio performance of the work for which this permit is issued, I shall employ persons subject to workman's compan s- cion laws of California." The applma mus all fpr all requved inspections. Complete drawing on verse side. Signed x Title: �roJect �yu Y09�0s� Date: /2'S//�J FOR DEPARTMENT USE ONLY el --22- 9 9 /y� Application Accepted by • ' ' // L Date t+" • At" 015 Pit or Grout Inspection by ate Fin 1 1 s ction by 7 - Dap Additional Commanu: Applicant - Return all copies to: San Joaquin County Public Health Services � ! �� Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stan, CA 95201 FEE INFO I AMOUNT DUE AMOUNT REMITTED CASH 2 RECEIVED BY / DATE G�- I�PEER/MIT'NO. .H 13-24 tate.t r.,H j �O IL41-S fg �.3 s Im6, EN 14-M 1