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SU0011041 SSNL
Environmental Health - Public
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SU0011041 SSNL
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Entry Properties
Last modified
5/7/2020 11:34:55 AM
Creation date
9/6/2019 10:55:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0011041
PE
2622
FACILITY_NAME
PA-1600201
STREET_NUMBER
16400
Direction
N
STREET_NAME
LINN
STREET_TYPE
RD
City
LODI
Zip
95240-
APN
05311004
ENTERED_DATE
9/6/2016 12:00:00 AM
SITE_LOCATION
16400 N LINN RD
RECEIVED_DATE
9/2/2016 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\L\LINN\16400\PA-1600201\SU0011041\SS STDY.PDF
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EHD - Public
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APPLICATION FOR PERMIT I <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> . ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> Duce IT SIRES 1 YEAR FROM DATE ISSU$D t <br /> 1 (Complete in Triplicate) <br /> 1 permit work <br /> ApplIcst4on is <br /> is sedebinmoe@tO� ITOO(ItrithuSanOJoaquiounty n Counr a Ordinance NO. 549 and 1862 and the eRules band eRegulations of San <br /> app <br /> Joaquin County Public Health Services. /� ���6nK <br /> C-`7/Q -Al Al� !S4_0 <br /> City lt;�-+[/j�"` �2 Lot Si <br /> Job Address <br /> Owners Name , ` 1: 19,t,/(C-1<-=— Addrets �Jr��'s Phone <br /> e�Slj- <br /> 'v. License No.�J �d �✓ Pl+on <br /> Contractor�_ L+ <br /> Address 4 <br /> TYPE OfWE�L�PUMP: NEW WELL ❑ WELL PLACEMENT O DESTRUCTION O Out li Be rvice Well ❑ <br /> PUMP INSTALLATION ❑ " �+_ SYSTEM REPAIR ❑ <br /> OTHER 11Mopitoring well ❑ <br /> DISPOSAL PLO. PROP. LINE <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES,,- <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL'r-PROBLEM AREA „CONSTRUCTION SPECIFICATIONS Dia. of Well Casing <br /> Bonom ❑ Manteca Dia. of Well Escavation _ <br /> ❑ Industrial ❑ Open- .,�U `Y �--r-^^ Specifications <br /> ❑ Oomeatic/Private ❑ Gravel Pack 0 Tracy TYPe of Casing_ <br /> C1 Olhei ' 71 Delta` t,w i Depth of Grout Seal Tyle of Grout ,� <br /> I'I Public 1 <br /> I I Irrigation —Approx. Depth I 1 Eastern SuHace $eal InsteNed by <br /> O i <br /> State Work Done _ <br /> Repair Work Dona L7 TYPO of P.-wnD�- H.P. ng Material i Depth <br /> WeU•Destru`gi "`TT Wel Demeter filler Material i Depth <br /> Depth _ <br /> • TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRiADDITION- DESTRUCTION l I avao <br /> se <br /> ilable within witys <br /> hin 200 feo septic system Par",eLlad it DuWit saw'er is <br /> Ate: <br /> IM[aNatgn wdl nerve: Residence_ Commercial_ Other f <br /> Number of trying units: __ Number of bedrooms - t <br /> t _ i Water table depth i <br /> Cttarscter of sole to a depth of 3 fast: _ _ I <br /> ^ Capaohy_„_ .. .�N&Compartrrents <br /> SEPTIC TANK ❑ Tvp /Mf9 -.-.._.�..�- - „ '-� Method of D'nywsal <br /> PKO. TREATMENT PLT. ❑ - � [ <br /> •• .; Distance to r omm: Well ! �.:F,oirrideliat r property Lie <br /> Total length/eke <br /> LEACHING UNE C1 No. b Length of lines �.'+ Pro Line <br /> FILTER SED O Oistari to neatest: 'Wall 1Op /�Foundetion” / Patty <br /> � �.a. ""1 Number <br /> SEEPAGE PITS it Depth 2 S <br /> Size"_-�- <br /> 15 <br /> SUMPS <br /> Cl Distance to nearest: Was cFounMfan � ( Property Line <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that I have Prepared this application and that the work will be done in accordance with San Joaquin county ordinances,state laws, and <br /> rules and tegulatiore of the Son Joaquin County <br /> Home Owner d,Iican"d agent's signature certifies the following: "I certify that in the performance of the work for which this Derma ontrutd, I ignature <br /> employ any person m such manrtm as to become subject to workman's compensation levn of Cal Nornia." Cantroctofa hiring or subcontracting sig <br /> cartMlea the following: -I certify that in the performance of the work for which this permit is issued, 1 shall employ persons subject to workman's ccntparua <br /> lion Iowa of C$Nlwnia." ' <br /> The Ncalt <br /> oppfor direquired ins. Complete drawing on towline side. <br /> Title: <br /> Signed n <br /> 7 N4 <br /> ls0 D RTMEN USE ONLY Area <br /> Date <br /> Application Accepted by .. J <br /> �� _ - 'Pinel Inspection <br /> "/Ph br Gta+t Inapaetbn by T Daia <br /> LJ f: <br /> AQditio+A Comrtentn, <br /> .Applicant -•Reium=ai.hcnpieaTto,: SnvirobsentaloH althuParmit/Servicesvices <br /> t 446 N San JoaP O BO- 2009, Stkn, CA 991,1 <br /> 5201 <br /> quin, <br /> FEE AMOUNT CIA { AMOUNT REMITTED RECENED aY OATE PERMr7NO. q) <br /> a^- <br /> i <br /> . EM 13.24 tPEV.veal <br />
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