SU0010861 SSNL - Laserfiche WebLink

Home Browse Search

' APPLICATION -- SR # 5� SAN JOAQUIN COUNTY PUBLIC HEALTH S VICES ENVIRONMENTAL HEALTH DIVIS ZIpD # Snl9Ll _ 445 N SAN JOAQUIN,PHONE(209)46 -gAb # P O BOX 388,STOCKTON,CA 95201 §t PERMIT .EYPIRB,5 I YEAR FROM T UID ��3� (Complete in Triplicaie Application is hereby made to San Joaquin County for a pemlit 10 conuruet and/or install the Work herein described.Ibis application is made in compliance with San Joaquin County Development ^Title Section 9.1110,3.,and Section 9.1115.3 and the Rules and!Regaitatiionns of Sen Joaquin County Public Health Services. Job Address �,-,{,L11.L�.�JC.j.� �. _, City 1-421 05 ! Lot SSee/Acrecge _ r lz. =s�•r_da=e� e><r�stc� hk Owner's Na � Jr Phone Contractor - Ft.ft-e C Address r l �3f'-77 License No. �l Phone 93 TYPE OF VVELLIPUMP: NEW WELL CJ WELL REPLACEMENT LI DESTRUCTION 0 out or Service 4e12 Cl PUMP INSTALLATION C SYSTEM REPAIR D OTHER C Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK _ SEWER LINES DISPOSAL FLO. PROP LINE _____ w FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS ._ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS r\ Ll Industrial ❑ Opan Bottom I Manteca Dia of Wall Excavation_ Ai -sung O Il Domesbe/Priwle Ll Growl Pack CJ Tracy Type of Caaing______ RIF t(:pecrflc p� Il Public 1 Oih*r 11 Delta Depth or Grout Seal ----g1� lETT��.• ddI rTi O I I IrFpauon _Appros. Depth + I Eas1Nn Surface Seal Installed by f-i t"rt 2 Repair Work Oona U Type of Pump M.P. $fists WolnekIDd9sj�JJiQ�1Ifi k:Hieii+I 4' l iV Watt Destruction Q Well Diameter Scall ng Material L Depth Pi lRt ;!' Depth _ _ Filler Material k Depth ENV1R0,''p,1h,`TAl }I%^'iia nl+jf,5'h7iti TYPE Of SEPTIC WORK: NEW INSTALLATION 11!" REPAIR/ADDITION It DESTRU TION I I (No septic system Permitted 11 Public wrest is ' available within 200 IeeInatatiOn will serve. Realdance_ Commercul✓ Othsr ,�/+/ ~ �`v\ Number of Iwmg units:_ Number of bedrooms Character of sole to•depth of 3 feel: Water table depth SEPTIC TANK Typal Mlp Capayy nes No. Compartments PKG. TREATMENT PLT. Cl &1A1J ,JP1 Method of Disposal Distance to nearest. Well- Foundation!_ Property Lina 1 _ -M -- LEACHING LINE yt}.-No. 8 Length of,*nae I�]n _ Tors length/sus t9 FILTER BED ❑ Ooslance to nwrear: Welt Foundation - Property Lina ' SEEPAGE PITS I I Depth —Sire Number SUMPS LI Dittance,to nearest: WNI Foundation ` Propi l Lina DISPOSAL PONOS I hereby certify that I have prepared this app1watwn and that the work will be done in accordance wnh San J"Win county Oldimnces, slate laws, and rules and reQO4140M OI Ity San JOaqun County Home owner or licensed agent's iignemis rer certifies the following: "I certify that in the performance of the work for which this permit is sued, I shall not employ any person in such manner as to becomes subioct to workman's compenaaUon Owe of Cakfotnoa." Contrntoe s hiring or sub ontgcting ognei certifies the lolbwing:"I certify that in IM performance of the work for which this permit is issued. 1&hall employ Parsons subject to workmen's compensa- tion lasye or CeldotnN." The opplcone must Call for aK r*quoted iin�s iecbons. Complete drawing on raver"sort*. Signed X-_f✓_1,/"'- Ily[rF�^' Title: (biAW— FOR DEPARTMENT USE ONLY --L,�G� ort Application Accepted by DSI* Amey"� Pit or Grout Inspection by Date�r Finest Inspection by -'%mac>ic l.�.. note / Additional Comments. up' l .eF J'^ O�E.P�Ti Y'd�Y,1E/cLsK> c�C app licnnt - Return all coplea to: San Joaquin County Public Health Services Environmental Health PermiVServices 445 N.Stn Joaquin.P.O.Box 389,Stockton,CA 95201 0388p 60 a � NFO AMOUNT DUE AMOUNT REMITTED iCA „ gECENED BV DATE /_` PERMIT N0. �tsf1✓ �a l +-�l—l� y s(";,-xJ H;s .aroi� {/7i�o -1 . 06)