SU0002607 - Laserfiche WebLink

Home Browse Search

7 ' Stn JOtOLi'• LOC?. --*-LTH 3:5'KILT > K 1601 E. XA.ELTO1, AVE., STOCKTON. CA PERMIT NO. 73— !`y + Telephone (209) 461,1-6781 i0 DATE ISSUED7161 n PERMIT E/FIRES 1 YEAR FROM pATF ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 519 for sewage or No. 186? for well/pump and the Rules�ajnd�Regulations of the San Joaquin Local xealtn District. J Job Address VAC'p2 /'�'JliewFas&g Subdivision Name_ i ' Owner's Name d6//�'s�A�?4c: &K Address S-411-LO Phone _ (c Contractor's Name J�SRUa.,. Cleanse No. 2�/--243 Phone a4/LL�L07 r.' TYPE OF WELL/PUMP WORK: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION❑ PUMP INSTALLATION ❑ SYSTEM REPAIR Lj OTHER L 1 n9 4 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _DISPOSAL FCD. PROP. LINE '9 ' FOUNDATION AGRICULTURE WELL _OTHER WELL PITS/SUMPS _ •� RINTENDED USE TYPE OF WELL PROBLEM AREA CDN5TRUCTION SPECIFICATIONS C ❑Industrial ❑Oben Bottom ❑Manteca Jia. of Well Excavation ❑Domestic/Private ❑Gravel Pack EJTracy Dia. of Well Casing ❑Public E]Other ❑Delta Type of Casing Irrigation Approx. ❑Eastern Specifications ❑Catec Cathodic Prottion Depth Depth of Grout Seal Geophysical Type of Grout V (❑Other Surface Seal Installed by t Repair Work Gone I] Type of Pump X.P. State Mork Done Well Destruction CJwell Diameter Sealing Material (top SO') y . 1 Depth F1' er Material (Selo. 50') ? • TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPAIR/ADDITION 7NC (N. septic tank or seepage pit permitted if public sewer is available within ?00 feet.) (. Installation will serve: Residence Commercial _ Other - jl Number of living units: �_ Number of bedrooms _Lot size 3 f/G. wp> Character of soil to a depth of 3 feet: G ZA^4 Nater table depth YL T- R SEPTIC TANK W( Type/MfgF494,sy 4;0i4 Capacity 7-" No. Compartments Q PKG. TREATMENT PLT. ❑ Type/Mfg Capacity Method of Disposal _ .'SEWAGE SYSTEMDistance to nearest: Well Foundation Property Line DESTRUCTION C] — LEACHING LINE No. a Length of lines .; 'Sf0 V Total length/size FILTER BED ❑ Distance to nearest: Well /De Foundation Property Line , SEEPAGE PITS DepthSize 3 3 Number g SUMPS L� Distance to nearest: Well /00 Foundation Property Line A-Air _ DISP05AL PONDS I hereby certify that ( 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-M e'640 Joaquin Local Health District.. Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for whieh this permit is issued, I shall not employ any person in such manner as to become subject to workman4 compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: -1 certify that in the performance of the work for which this permit is issued, 1 shall employ persons subject to workman's compensation laws of California." The applicanrtYmufst < 1 for a requi msp cf ions. Complete drawing on reverse e. Deco: — Signed a//�R'i � Title•. ZS T/ FO ARTM 'T USE�I]YAree �' y 7�FJ❑ Stk 066-6781 Application Accepted by _4 ❑ Lodi 369-3621 Additional Comments: C Manteca 827-710a Pit or Grout Inspection by Date __7_ LJ - Final inspection by Date 7^d- „ L7 Tracy 835-6385 Applicant - Return all Copies to: Environmental Health Dermit/Services 1601 E. Ha:^lton Ave., P.O. Boz 2005, Stk., CA 95201 PERMIT R0. ' FEE BASE ;,MWNT DUE �AMOUNTrTEp P.ECEIVED BY j DATE INFO I "2Z: 10182 500 EH 13.21 REV. 10/1`: 1a-26