SU0006105 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN OAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P 0 BOX 2009, STOC%TON, CA 95201 (209) 468-3447 pEgMTT EXPIRES T 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 Ban Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Ban Josquln County Public Health Services. G. Lot Size/Acreage AG/R r ES Job Address �D 998 S fi<A/2 LA.t/ R D City.G ' Fc9 dPhone d xs Owner's NamerNaR2Airess PaBeKi Contractor FLOYO E I&Le& Address 7 N ADSL®�Rr iQ1/E License No. *4�- r7a Phone LSS397/ TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 11 DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM RE A CONSTRUCTION SPECIFICATIONS Cl Industrial ❑ Open Bottom ❑ Manteca D' . o Well Excavation Dia. of Well Casing U Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications 0 Public 17 Other U Delta Depth of Grout Seal Type of Grout ❑ Irttgation _Approx. Depth ❑ Es n Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done_ Weil Destruction ❑ Well Diameter Healing terial A Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIR/ADDITION Cl DESTRUCTION G IN. septic system permitted it public sewer is available within 200 feet.) Installation will verve: Residence_ Commercial4/ Other Number of living units: = Number of bedrooms Character of soil to a depth of 3 feet: SAND Y C Water table depth SEPTIC TANK j- Type/Mfg GC. -P91 L Capacity DLo,170 No. Compartments Z f PKG. TREATMENT PLT.Ll Method of Disposal Distance to nearest: ell Foundation /-S Property Line LEACHING LINE No. g Length of lines L*; length/size 00 FILTER BED ❑ Distance to nearest: Well 2a494- Foundation 30 Property Line /00'~ SEEPAGE PITS I I Depth Sire Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O 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 County Home owner or licensed agent's signature certifies the following: "I cartify 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: '9 certify that in the performance of the work for which this permit is issued, I shall employ persona subject to workman's compensa- tion laws of California." The applicant must cell 1 r all required incpections. C mplate drawing on reveres si1de. Signed !/� Title: Z - Date: 1d-/9-90 FOR DEPARTMENT USE ONLY ` Application Accepted by Dater'© -`-`� `O Area Pit or Grout Inapectio Date Final Inspection by 01,9, Date i'/' ?0 Additional Comments: Applicant - Return all copies to: BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOX 2008, STOCKTON, CA 95201 FEE INFO ``AMOU[NTT�/DDUU�E 1AMOUNT REMITTED CASH �)(R.ECEIVEO BY DATE(, nyPERMIITT.,�/N�O..� . ,H 3.N IIIEV.mel ` `y _ ILA, N 1 V � I�—lf --lo [Q (/`WI E H :410