SU0006274 SSNL - Laserfiche WebLink

Home Browse Search

APPLICATION ��pp uu SAN JOAQUIN COUNTY PJBLIC HEALTHSSR# ¢+� ENVIRONMENTAL HEALTH D I V I QNB u 4�(S 445 N SAN JOAQUIN, PHONE (209) 113 P O BOX 2009, STOCKTON, CA5� PERMIT EXPIRES 1 YEAR FROM DAT f� als� (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 in Sade in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 2800 N. Jack Tone Rd_ Cate Linden Lot Size/Acreage GreenlaW Grupe 3255 W. March Lane Stockton Owner's Name Address r Phone ConttactorPLIrvianCe Drilers1Inc Address P. O. BOX 64ELinden License No 377923 Phone 887-3554 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT R DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION)U 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 AREA CONSTRUCTION SPECIFICATIONS _ } L) Industrial 60 pen Bottom ❑ Manteca !Dia. of Well Excavation Dia. of Well Casing `,11 Cl Domestic/Private ❑ Gravel Pack ❑ Tracy _Type of Casing_ Specifications I'1 Public I1 Other 1-1 Della !Depth of Grout Seal Type of Grout i 1EXlrrigadon _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump tUrb H.P. 50 State Work Done _ Well Destruction ❑ Well Diameter Sealing Material i Depth Depth FillerlMaterial i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I 1 DESTRUCTION I I INo septic system permitted it public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial_ Other Number of living units: _ Number of bedrooms A/� Character of wit to a depth of 3 feet: Wate��r+'7�I�a�6'T`a/��+. VAENT- SEPTIC TANK ❑ Type/Mfg Capacity No. "" at-w PKG. TREATMENT PLL ❑ ,. Met�Wf1o5 Oisoesa� Distance to nearest. Well Foundation Proper{yA',"�I JAI//ii IICC LLUINOo COUNTY LEACHING LINE ❑ No. 8 Length of lines Total IsrE/ ICES FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 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 fegulations of the San Joaquin County 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 a st call for d inspections. Complete drawing on reverse side. Signedd\K1-�•s•�=x� - Title: Corporate Secretary Date: 3/25/94 FOR DEPARTMENT USE ONLY Application Accepted by Date Area � Pit or Grout Inspection by Date Final Inspection by Date �E Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE�3 9 'o h NFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVCK li E BY ATE PERMIT NO, EH t3 N IAIN.r i/n v ��• S/ EH 14 3a