SU0007907 (2) - Laserfiche WebLink

Home Browse Search

' SAN JOAQUIN COUNTY PUBL_LG :HEALTH S.E17VVICES ENVIRONMENTAL HEDIVISION 445 N SAN J2009 420 , STOCKTON,2CA,95203. POBOX qL PER.ULT, EXPIRES 1 YEAR FROM DATE IOUED (Complete in Triplicate) j Application is hereby made•to San Joaquin County for a permit to construct and/or install the trork herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1562 and the Rules and Regulations of San Joaquin County Public Health -�Services. ��c8I*k2.65-0990`-13+14 � Job Address- et ant+- ;l�p tt BIr -Bte—wg-OT Fd6 City Tg�C4 Lot Size/Acreage `x 2-05 01161484- 3319 Owner's Name �r�_Ear-m-s Address TO.Box 9 13 Phon 9_ B4 "' ZB 1 -7- g5t51 (410 4$4-33Z Contractor 1e1 � Address 0.�d7f 15(�OZ_ &License No.��Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 0 DESTRUCTION 0-but of Service Welt '0 - -PUMP INSTALLATION 0 - - SYSTEM REPAIR ❑ OTHER DE Will ift tori ar- DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE�f.�l�1� C3b� FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPSp+�j 1 4 6/ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS - Ir I n industrial ❑ 00en-86ttom ❑ Manteca,+ -Dia.of Well_Excovation Oia. of Well Casing 0.V ^5 tEl Domestic lPrivate ❑ Gravel Pack ❑ Tracy Type of Casing-- 11 pecifications I'I Publrc (l Other n Delta Depth of Grout Seal Type of Grout I I Irriljation Approx, Depth I I Eastern Surface Seal installed by Repair Work Done U Type of Pump H.P. State.Work Dg Wall Destruction ❑ Well Diameter Sealing 6laterial i Depth + tb woew- Depth Filler Materiali�De tits E 1 Gaser►!'J1+ TYPE OF SEPTIC WORK: NEW INSTALLATION l ) REPAIRlADDITION I 1 DESTRUCTION I I INo septic system permitted it public sewer i$ available within 200 feet.) Installation will serve: Residence— Commercial— Other Number of living units Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK. ❑ Type/Mfg Capacity No. PKG. TREATMENT PLT.❑ Metz, f i t5"sa Distance to nearest: Well Foundation Property Li�IEG MU - - - - 0 4tv LEACHING LINE ❑ No. & Length of lines Total length/sue IfAl 5 FILTER SED C l Distance to nearest: Well Foundation Properf Mhe�a) ,4.&F PUBLIC �jti V tStc SEEPAGE PITS I I Depth Sire Number E�VI SUMPS Lf Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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_re.90ations of tris San Jaaquin_County-,M�_ 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 tot which this permit is issued,I shall employ persons subject to workman's compensa- tion laws of California." The applicant mus#call for all required inspections. Complete drawing an reverse side. Signed r*YD Title: Gfo 4 Mttne9J-1 Date: _ , V192 / FOR DEPARTMENT USE ONLY Application Accepted by Bata __5_ Area Pit or Grout Inspection by Date Final Inspection by Oata Additional Comments: Applicant --Return all copies to: San Joaquio County-Public'Health Services i Environmental Health Permit/Services 445 N San Joaquin, 0 Box 2009, Stkn, CA 95201 CCKFEE INFO AMOUNT DUE AMOUNT REMITTED ,.SIT RECEIVED BY DATE PERMIF'NO. . Eirt}2strafv.,.NS) c5� . 1� -(� ]Z�IO tS I� q>_1 ' Eir tFYe