ARCHIVED REPORTS XR0006463 - Laserfiche WebLink

Home Browse Search

rj !11'f�{ ll .,TI`lfJ I (tri l'f RMil + SAN JOA(ILJIN LOUAL Ilf_ALl II DISTRICT it-111 I fIAIEti ON AW S I OCKIC)N, CA D,t.�l.tC•r 11111111ifkirttr GNfJ) •lbt-) b/111 15.O1 v YEIIMIT kXF'ifiE5 1 YCAfi FROM []ATE ISSUF I 1 It-1 lCortiplDiu r[I 1Ilphratti) `fl,OA&.% �`� Application is hereby made to the San Joaquin LO[df Health District far o peimu to cnnslrucl and'or instate Ili oTEC herein described T1rs application is made in compliance wotti Sdn Joaquin County Ordrndrrce No bag fur sevvmlae ur Nu 18b:fur v ellrt,ump and the Rules and Reguidt.ons of the San Joaquin Local Health District Job Address �x_2' South of Douglas & 20' fist Of 1,DoaC41C City_$tock � Lot Size N A PM Owner s Name _P09�-1 - A W-IoZkland W_m• _-- Addrt,ss 1765 Sac-anMtO Phone (916) 921-1100 Contractor WBStern Aca.ess 1386 E• B53rrOt' St-, j'��113 License N§13857 Prtone(916) 662-4541 TYPE OF WELL/PUMP NEW WELL t WELL REPLACEMENT [ r DESTRUCTION ❑ PUMP INSTALLATION L7 SYSTEM REPAIR C3 OTHER ❑ DISTANCE TO NEAREST SEPTIC TANK _N�'� SEWER LINES 50' DISPOSAL FLD WA PROP LINE NSA FOUNDATION N/A AGRICULTURE WELL N/A OTHER WELLDPn1� PITS/SUMPS NSA INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS * Industrial CI Open Bottom I ' Mdrrteca Dia of Well Excavation 1010, Dia of Well Casing 411 ❑ Domesticl Private 124 Gravel Pack I I Trdcy Type of Cat.ong EW Specifications I 1 Public I 1 O[her VJ Delta Depth of Grout Seaf03 _ Type of Grouthat-i ite t I Irrtgdtion __- Approx Depth I I Eastern Suoface Sedl Installed by 4J•2--qf-Pm Qaa=Ej= warn Repair Work Done lJ Type of Pump H P _ State Work Done Well Destruction O Well Diameter _10" Sedling Material Itop 5D I (30'] K-Af-,rpt-. + S% hmtr 7tt-P- Depth 65' Filler Material 18alow 90 1 (3fL1) #3 Vent-= sard TYPE OF SEPTIC WORK NEW INSTALLATION I I RLPA1RfADDITiON I DESTRUCTION I I (No septic system permatred of public sewer is available Wilhm 200 feet I Installation will serve Residence — Commercial— Other Number of living units Number of bedrooms _ _µ_�� v Character of soil to a depth of 3 feet Water table depth SEPTIC TANK L1 Type/Mfg Y Cdpacaty No Compartments PKG TREATMENT PLT f-) Method of Disposal Distance to nearest Wall __ Fooinddtion _ Property Line LEACHING LINE f l No S Length of lines _ _ — _ _ Total lempth/sire_ FILTER BED I I Distance to nearest Well _ Fouridation Propeny Line SLt?AGE PITS I I Depth Sire _ _ _ Number SUMPS l I Distance to nearest W.a Foundation Property Line DISPOSAL PONOS I 1 I hereby certify that I have prepared this application and ilidi The wori, wal Ira Acini iii accorddnce with San Joaquin county ordinances state laws, and rules and regulations of the San Joaquin Local Health District Home owner or licensed awont s signature eernfies the tolh�v ioi p I r.crld* Thal in the IA tformance of the work for which this permit is issued 1 shall not employ any person in s h mdi ner as to become subject to ,urkindi+ Lumpensdt,rm laws of CdOornrd Contractor s hiring or sub-contracting signature cenrlies the f„i ♦inrd , unity that in the performance of thu work for which rhos permit is issued I shall employ persons subject to workman s compensa tion laws of California The applicant must for all a 10 Complete drawing on reverse side SAN JOAQL=IN LOCAL HEALTH DISTRICT ENIVIRONMENTAL HC 6�'1'90N Signed X Title '' � _ ��fifa , FOR DEPARTMENT USE ONLY Applrca on Accepted by 1 f ---- Data Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments ❑ Stk 466 6781 O Lodi 369 3621 U Manteca 823'104 [ 1 Tracy E35 6385 0 Applicant Return all copies to Environmental Health Pernut/Sdrtioies 1601 E Hazelton Ave P O Box 2009 Sik CA 95201 FEE AMOUNT DUE AMOUNT REMITTED �kSYI HECkivED BY DATE PERMIT NO INFO ` EH 1121 tAEV it%5i :� _ �� % I~ 1. �� 4 �CA EH 14 76 $� `.,zo