SU0003429 - Laserfiche WebLink

Home Browse Search

NOW APPLICATION FOR PERMIT OD SAN JOAQUIN LOCAL HEALTH DISTRICT PAYMENT 1601 E. HAZELTON AVE., STOCKTON, CA RECEIVED Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED AUG 1� 19 `3 (Complete in Triplicate) �►.IyIRONMENTAL HEALTH Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the worki � i0Ciiis application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rule n eg lat�ions of the San Joaquin Local Health District. Job Address 27300 N.Sowels Rd. city ACampo Lot Size 10aC, PM 95-4240 Owner's Name Bob Kent Address P.C. BOX 1391 Lodi,Ca Phone A Galt,Ca.95632 Contractor Woods Well Dr1Ain9ddress 11944 Simmerhorn License No. 282866 Phone 745-2407 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATIONXX SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 150 t SEWER LINES 150 DISPOSAL FLD. 11 So PROP. LINE - tt FOUNDATION 50 t AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Tr El Industrial Open Bottom ❑ Manteca Dia. of Well Excavation >t Dia. of Well Casing 81t Domestic/Private ❑ Gravel Pack ❑ Trac T Steel ,�J y Type of Casing Specifications FI Public ❑ Other F1 Delta Depth of Grout Seal 50 , Type of Grout sand.ceITf t I I Irrigation _ Approx. Depth I I Eastern Surface Seal Installed by Woods _ Repair Work Done ❑ Type of Pump Submersi4p 3hp State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is () available within 200 feet.) 7J Installation will serve: Residence_ Commercial Other Number of living units: Number of bedrooms (� Character of soil to a depth of 3 feet: Water table depth (� SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments �/v PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line L/ SEEPAGE PITS I I Depth Size Number SUMPS Ll 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 regulations of the San Joaquin Local Health District. 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 applicant must call for al re fired ins ions. Complete drawing on reverse side. Signed X ,� � Title: Contractor Date: 8/19/88 FOR DEPARTMENT USE ONLY Application Accepted by {� Date J Area Pit or Grout Inspection by Date inal Inspection by-!// Date Additional Comments:/f`% ❑ Stk 466-6781 D Lodi 369-3621 ❑ Manteca` 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK INFO RECEIVED BY DATE PERMIT NO. /'�� . EH 13-241REV.Ii R 5) `0••- - /�l EH U-29 v'