SU0004325 - Laserfiche WebLink

Home Browse Search

'./APPLICATION FOR PERMIT pAYMgNT SAN JOAQUIN LOCAL HEALTH DISTRICT REGEIVED 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 NOV 9, 519A� PERMIT EXPIRES 1 YEAR FROM DATE ISSUED MENTAL HEALTH (Complete in Triplicate) FNVIRpDO�QQkk� Isc VICES Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein deicYfDed'TThia application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health 3strict.� Job AddreAtast Fremont Street city Stockton Lot Size 7,000 ft.2 PM Owner's Name Joe A. Plattos Address 724 N let San Jose, CA 95100 Phona(408) 295-2442 Contractor Kvilhaugh Well DrilliAWress 1676 Risdon Rd., ConcordLicense No.482390 Phone (415) 685-6 i 13 TYPE OFL / P: -NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 111; 4 monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 73-165' SEWER LINES 35-200' DISPOSAL FLD. — PROP. LINE 6' FOUNDATION 77-127' AGRICULTURE WELL OTHER WELL104-144'PITS/SUMPS 22-153' 1mi INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation nC es Dia. of Well Casing ❑ Domestic/Private N Gravel Pack ❑ Tracy Type of Casing PVC sch 40 Specifications 1-1 Public (7 Other Cl Delta Depth of Grout Seal 29 ft Type of Grout cement I I Irrigation —Approx. Depth RI Eastern Surface Seal Installed by driller _ Repair Work Done ❑ Type of Pumpnone H.P. none State Work Done_ none Well Destruction ❑ Well Diameter 11 inches Sealing Material (top 50') none Depth 60 ft Filler Material (Below 501 none TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is 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. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size I FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS L) 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 m call for all required it spections. Complete drawing on reverse side. LAW ^ Signed X Title: 5�4 w. Date: �7AW FOR DEPARTMENT USE ONLY Application Accepted by •—ell {�" Date / Area — Pit or Grout Inspection by Date I 0 Final Inspection by —771! - Oe ' Date / a� Additional Comments: ❑ Stk 466-6761 ❑ Lodi 369-3621 ❑ Manteca 823-7100 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEEAMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. NFO r 1 . EN 13-24IREV.IIA 51 3$'0) 1�" �_Z�-,�P P✓- 1�o EH 141a