SU0003012 - Laserfiche WebLink

Home Browse Search

APPLICATION ` I SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES j:n I`�`�� O I Z ENVIRONMENTAL HEALTH DIVISION KA Job 445 N SAN JOAQUIN, PHONE(209)469-3420 P 0 BOX 388, STOCKTON,CA 95201-0388 20-3821-01 .GO 1 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described.This application is made in compliance with San Joaquin County Development Title Section 9-1110.3 and Section 9-1115.3 and the Rules and Regulations of San Joaquin County Public Health Services. APN #193-270-02 Job Address 101 89 '011th LTar-1 an RA City French Campt Size/Acreage 17 acres Owner's Name Gary Howard Address P • 0 . Box 12346 , Fresno, 937710hone Contractor Spectrum/Kleinfel"�ss2825 E. Myrtle St License No.512268 Phone948-1345 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ -EsTdtUeTi6At El9at a-Rervt ce-Heti--0 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER R Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. -PR0P.-LN4E 1. 1 borings FOUNDATION AGRICULTURE WELL OTHER WELLPJT#SOWG 2Q' Deep INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 6" Dia . ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation nom. ofYJaLLCasing CI Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing- -spa cificationr Nn Gw I'I Public I1 Other n Delta Depth of Grout Seal -Typebf-GretiL lCl Dated 1l Iodation _ Approx. Depth Il Eastern Surface Seal Installed by Tf rW Pnrnnntararl wi 1 Repair Work Done ❑ Type of Pump H.P. -- State Work Donob--C f ill ltr1th 'hole lug' Well Destruction ❑ Wall Diameter Sealing Material i Depth Depth _ Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION i I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public "war at available within 200 feel.) 0 Installation will serve: Residence_ Commercial_ Other Lb Number of living units: _ Number of bedrooms 0 , Character of veil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Typo/Mfg Capacity No. Compartments n PKG. TREATMENT PLT. ❑ Method of Disposal v 1 Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Founcahon Property Line SEEPAGE PITS 11 Depth Sire Number 7- SUMPS LI Distance to merest: Well Foundation Property Line }+►,,f`1" DISPOSAL PONDS ❑ PAYM E-M ! I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 4;c)VWrVr6t Islets Laws, and rules and regulations of the San Joaquin County Hyt ff t` 1q 4 Home owner or licensed agent's signature certifies the following: "I certify that in the Performance of the work forw�}th{this pernmLL4 �l�. 1 shall not me employ any person in such manner as to becosubject to workmen's compensation laws of California." Contrac;w'al hfrmq orlabbic&Aiia ting signature certifies the lollowing: "I cenify that in the performance of the work for which this permit is issued, I shall employ geraohT aNpjacl'o wolkman'a.t6tnpense don laws of Califor :a." The applicant s ca for • require ins omplete drawing on raver" side. Signed X ✓ Title: Senior Engineer Date:11-8-94 R DD/E/APARTMENT USE ONLY /XI'") Application Accepted by `r Date a Pit or Grout Inspection Dy�� 1Date Final Inspection by U Date/ Additional Comments: '/< Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N.San Joaquin,P.O.Boz 388,Stockton,CA 95201-0388Pf- a 1 INFO FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED By DATE PERMIT'NO. C/rr N IN EN 14a•Ia EV.vnel s� Jam— 1 • r „[ 1 1-1 D �` a al 'J ^Y. / l