ARCHIVED REPORTS XR0006463 - Laserfiche WebLink

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,tTltli. I lilt I 1 Iti�til _ r .. SAN .I()AQI$IN I tit-Al. I It r\l Ill DIS,T1111'T 1tAl 1 114.11 O': A vt S 1 L)t'T, T C)N, CA _ I t hit'fit irtu I Sr 111 .lfut t,71:11 11•1111MIT I X1'1111 'N 1 Y! Ail IIMM OATk IfoStJCL) tC utiilt4i14 1 1I 11 Ip11,.jIf) Application ra hdiedy mado to the Sdn Jr,eriu,n Lor✓i tludflrt G<elfiLt i.,r d pvrrnir to Lnnalruc[ dng7of tn4(Ap-Ipre "W".lrsretn deicribc`r, Thr&applicdbon is made on complidnce wear Sari Ju.,uu n Cuitnry ilnl-nani a Nr, 1x19 fur %iqri u+ Nu 18b2 Tui wellipuilip,and tllri_flLlua end Haguiauons of the San Joaquin Local Health Distract Job Address Stix 9O north if D:U las & 24' East Of C ty _aocktm Lot Size _ NIA Plus Owner s Name _=' A 1,'Ickland Oil_(b. ___ AddrLss 1765 ❑131Lerl2e 142ry, SaCX-cill It O � Phone (916) 921-11 GO Conlf3ctor WBSteM G30,-EhCrLr '�� Acciress 1386 E. BaNmr St., wxiclard License Ne513857 phone(916) 662-4541 TYPE OF WELL/PUMP_ NEW WELL I , WELL REPLACEMENT r3 DESTRUCTION 0 PUMP INSTALLATION Ll SYSTEM REPAIR [1 OTHER ❑ DISTANCE TO NEAREST SEPTIC TANK NSA M SEWER LINES 50' DISPOSAL FLD NSA PROP LINE WA FOUNDATION Nip' AGRICULTURE WELL N/A OTHER WELLPLD PITS/SUMPS WA INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION _SPECIFICATIONS ❑ Industrial I_I Open Bottom I I MantLca Dia of Well Excdvdtton 10" Osa of Well Casing 411 ❑ Domestic/Private iMl G(dVel Peck 1 1 Tracy Type of Calrng Specifications I 1 Public I OlhLr X Delta Depth of Grout Sedl _ 30Type of GrouLt I I Irnt}dtion _ Apiprox Depth 1 1 Edlttirn Surface $ual lnstdlled by_ Yk�Ct m Gsmck: �:Y rjee r"4 _•- Repair Work hone I ) Type of Pump _ H P _ Stata Work Done ._ Well Destruction L) Well Diameter —1(1" Staling Miter al (top �D) (10' t rwttr->:'rt•,+ 5% hantcnttR Depth _ ISS' — Filler Maleriat (Bolow 901 (3()_'_). #3 bbntQ= sand TYPE OF SEPTfC WORK NEW INSTAI LATION ! I REPAMiADI)ITION ' I DESTRUCTION I I (No septic syslem permalod if public sewer is avdrlable wilhin 200 feet 1 installation will serve Residence — Commercadl ___ 091;Lf Number of living units Number of bedrooms Character of sod to a depth of 3 feet _ —Water table depth SEPTIC TANK I J Type/Mfg —_ _ _ ___— Cap,aaty__ No Compartments PKG TREATMENT PLT 1-1 Method of Disposal Dtsidnce to nearest WLII _ FnunddLun __ Property Line LEACHING LINE I I No S Length ul lines y _ _ __ Totdl length/stze— FILTER BED I I Distance to nearest Well 1'r,ur,ddtion __ _ Property Line SEEPAGE PITS -�I 1 Depth S rn — _ _ Number SUMPS t Drstdnce to nearest 1h.if FOuntldUnn Property Line DISPOSAL PONDS E ! hereby certify that I have prepared this application and Owl the wit+t v.is Ut, tine in oLcuiLidnce with Sdn Joaquin county ordinances state laws, and rules and regulations of the ban Jodquin Local Ht,dlfh Dislnrr Home owner or licensed agent s siUnature certifius tiiu tulluwiny I rertd r shot rat the p,urluiinence of Our woik for which this perrrut is issued I shall not empty dny person in such rnannei os iu becornu lulgeLt to wwtlrrian s C„n Vt,nsdnun tdws of Cdlrfanua COnlidLtOf s hiring or sub-contraettng signature certifies the fo.iuwing I ctvrtif y ihdi In the p oil(jimince of tliu wui. for An cli 111q porm,l is issued I !flail trmpluy persons subject to workman s cornfAirsa tion laws of California SAN IOAQUIN LOCA! HEALTH DISTRICT The applicant mu all for r d ct n Complete drawing on reverse side ENViRONNIIENTAL HEA m 4/;SION Tide PiE.51t11v 9�Ei _ FOR DEPARTMENT USE ONLY ' 1 Ell, Apple lion Accepted by ?� �1 _ __— _-____ .._ Dete L �J �+ ' Area Pit or Grout inspection by _— Ddtn ____��—-_ Final Inspei tion by Date Additional Comments ----- --- ---- ❑ Stk 466 6781 ❑ Lodi 369 3621 1.J Manteca 823 '104 t 1 Tracy EL35 6385 Applicant - Return all copies to Environmental Health Permit/Serti,Ld! 1&01 E Hazelton Ave , P O Box 2009, Sik CA 95201 FEE AMOUNT DUE AMOUNT Ht Mit TED K !� 14ECCIVED BY DAIL PERM17 NO INFO - -- (.ASH a EH 1324INEV ir�al _1 EN 14 26 ; J