My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SU0004208 SSNL
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
R
>
RAMSEY
>
2621
>
2600 - Land Use Program
>
PA-0300144
>
SU0004208 SSNL
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/7/2020 11:30:33 AM
Creation date
9/9/2019 9:00:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0004208
PE
2632
FACILITY_NAME
PA-0300144
STREET_NUMBER
2621
Direction
N
STREET_NAME
RAMSEY
STREET_TYPE
AVE
City
LINDEN
ENTERED_DATE
5/14/2004 12:00:00 AM
SITE_LOCATION
2621 N RAMSEY AVE
RECEIVED_DATE
3/31/2004 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\R\RAMSEY\2621\PA-0300144\SU0004208\NL STDY.PDF
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
45
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
APPLICATION FOR PERMIT <br /> _ <br /> SA, <br /> ,,OAOUIN LOCAL HEALTH DISTRICT- <br /> 1601 E. HAZE i ON AVE., STOCKTON, CA <br /> I <br /> Telephone (209) 466-6781 <br /> - <br /> PERMIT • ; <br /> MIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> I <br /> (Complete in Triplicate) <br /> Application is he eby made to the San Joaquin Local Health District for a permit to construct and/or install the w.Qy11/ rein described./ j��pplication is <br /> �j i <br /> made in compliance with San-Joaquin County Ordinance No. 549 for sewage or No. 1Rti2 for well/pump and the Rules h e lahons of tNe�an Joaquin <br /> Local Health D,sinct <br /> pr,• � .� I <br /> si� <br /> Job Address 30d3�"• Vi Ci n01D K—� I APN - Obi -ow -5Z)ity 5 C/L Lot Size �rr �rN <br /> ,4evtM ; Ku{r.q Gtosrannoh, J_ / p , <br /> Owner's Name � .„ t �-L��r+0_ro4i51 Address ItI _ 1 gel ?6 Phone --3s <br /> —Contractor � L! /GN'n Address Z,825—,ff. In-y,—Alf License No. S(Z Z G r Phone _ �i s �� I <br /> TYPE OF WELL,PUMP. NEW WELL a WELL REPLACEMENT i i DESTRUCTION it IIII <br /> PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER �4 &,Eorac-14 /3ori'rhrz 1 <br /> —DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> i <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ ( _ f�I <br /> INTENDED IJSE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> `i I Industrial 1_1 Open Bottom (.i Manteca Dia. of Well Excavation�D tl— Dia. of Well Casing _ <br /> I I Domestic/Private 1.1 Gravel Pack I 1 Tracy Type of Casing Specifications <br /> 1'1 Public I l Other I 1 Delta Depth of Grout Seal Type of Gr it J�ZiLC '1q <br /> I Inu)auon _ Approx. Depth I I Eastern Surface Seal Installed byRepair Work Work Done Type of Pump H.P. State Work Done <br /> Well Destruction 1 Well Diameter Sealing Material (top 50.) :1 <br /> Depth Filler Material (Below 50') <br /> 'TYPE OF SEPTIC WORK: NEW INSTAI I ATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permuted if public se er is n, <br /> available within 200 feet.) ' <br /> Installation will serve: Residence Commercial _ Other <br /> Numoer of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK D Type/Mfg Capacity_ No. Compartments <br /> aPKG. TREATMENT PLT. F1 Method of Disposal <br /> Distance to nearest: Well Foundation Property Line t <br /> t�. <br /> LEACHING LINE 1:1 No. & Length of lines Total length/size ._.._ <br /> —FILTER BED I 1 Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS I I Depth _Size Number _ <br /> SUMPS I I Distance to nearest: Well Foundation ___ Property Line <br /> DISPOSAL PONOS I I <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 regulations of the San Joaquin Local Health District. <br /> — Home owner or licensed agent's signature certifios the following: "I certify that in the performance of the work for which this permit is issued, I shall not <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> 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 <br /> tion laws of California." <br /> The apphca nu t call for all required inspections. Complete drawing on reverse side. <br /> ,10�/� � <br /> C/ <br /> Signed X --- Title: � _ Date: 49kc --- <br /> _ XFOR DEPARTMENT USE ONLY 2 <br /> Application Accepted by //� Date /J / �T�� Area <br /> Pit or Grout Inspect on by Date Final Inspection by Date — <br /> r Additional Commnnt; T��/ 5 /T 7 <br /> L� Silk 466-6761 LJ Lodi 369-3621 U Manteca 823 7104 r ❑ Tracy 835-6385 led <br /> Applicant Return ),I :opiris to: Env ronmontal Health PormitSorvices 1601 E. Hazelton Ave., P O. Box 2009, Sik., CA 95201 <br /> "'. AMf�UNT DUE AMOUNT REMIT-TI D CK aI- RECEIVED BY DATE NEnMIt NO <br />
The URL can be used to link to this page
Your browser does not support the video tag.