SU0003309 - Laserfiche WebLink

Home Browse Search

PLOT PLAN (Draw To Scale) 111 SOAg E. -e . Names of streets or mads nearest to or bounding the property. Outline of the property, giving dii i-r en iOns and North direction. `$ r > Dimenisioned out Ines and locations of all existing and proposed structur �,inclu zing cover ed areas such as patios: 'driveways and walks. 4. Location of house sewer outlet, public sewer, sewage disposal system or proposed sewage disposal system, proposed expansion of sewaged4l system, or any other possible source of contamination. 5. 3 ocation of other wells within radius 6f 150 fe t on the property or ad oini^,g property. 6. Location of sewage disposal systorrlOn nd- lnix property or within a radius of 1:56 feet. T-- - --T - -�rI I - - - T — --T - — - ---- ' —� I A_ I 7 I 1 —j - — - y ' } I I ' i _ I ( I ' — — - -- --I I ! - — tvI I I ---f- II i 1 I ------------------ i -"rte .� 'I-' •_t 1 ; t i 1 ry T-' r��-.-• i -"_.--."-' —. _ f --- i 1 3 i r -•-,• Y.I IA a.-� I, ��i I=�� , ---d_ i D 1 -J-_..y_-..3�-- 1 ..j._.�. I ' I � I __T --1 -- —---4----�-- APPLICATION FOR PERMIT f P 1 SAN JOA IN LOCAL HEALTH DISTRICT ` t,. 1601 E. HAZELTON ON AVE., ST OCKTON, CA Telephone (209) -6781 E iT EXPIRES 1 YEAR FROM DATE ISSUED (COrnplete in Triplicate? 4 pplication is hereb Y made to the San Joe uin Local H l t 1 rJ i y ®a th Dist;District for a permit to construct and/or ins�all the work herein described. This application is made incompliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District., 1 Job Addressn ', t;rte kliW � `*$R� City *_ ' of Size PNi Owner's Name _W, �'; x*' '' Address _' r° Phone Contractor's Name License No. 4 � Phone }` r `TYPE OF WELL/PUMP: NEW WELL: 0 t';ELL REPLACEMENT DESTRUCTION PUMP INSTALLATION D SYSTEM REPAIR ❑ OTHER D DISTANCE TO ;NEAREST: SEPTIC TANK _ SEWER LINES; DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS;SUMPS INTENDED USE TYPE OF WELL , - PROBLEM ARFA CONSTRUCTION SPECIFICATIONS - D Industrial _ D Open Bottom ID Manteca ;` Dia. of,VJell Excavation _ Dia. of Well Casing. :=i Public Domestic"Private ❑ Gravel Pack D Tracy i Type of Casing Specifications D Public D Other C Delta 1 Depth of Grout Seal Type of Grout D irrigation ----Approx. Depth D Eastern Surface Seal Installed by Repair Work Done D Type of Pump �_ HP, State.Work Done Well Destruction D Well Diameter Sealing Materia: (top 501 Depth ;,Filler Material !Barlow }') TYPE OF SEPTIC WORK: NEW IfNSTAL'—\TION El REPAIR/ADDITION I" DESTRUCTION G (No septic system permitted if public sewer is r, instaliation wiia serge: residence_ Commerciavailable within 2('G fee*.) als"' Other r t Number-of living units: Number of bedrooms Character of soil to a depth of 3 feet: f i r Water table depth .. SEPTIC TANK D Type/Mfg Capacity +'` No. Compartments � '^- PKG. TREATMENT PLT. D Method of Disposal - 1 Distance to nearest: Well �/_K ndation Property Line y e LEACHING LINE D No. &Length of lines Total length/size = 1 Il TER BED D Distance to nearest: Well J`_ � bundation Property Line Slr�PAGE PITS D (degh �'} x r, resi _ I P i— t Number s SUMP D Disto nearest: Well t� f f., Foundation� � Pro _ISPOSAL PONDS Property Line D I hereby cardio'hat 1 have prepared this application and that the work will be dome in accordance with San Joaquin county ordinances, state 'laws, and rules and re gulatsCns of the San Joaquin, Local Health District. Horne owner or licensed agent's signature certifies the fol<o;ving: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person i9 such mariner as to some subject to workman's compensation laws of California."Contractor's hiring or su`contracting signature certifies the following: " certify that in the Performance of the work for which this permit is issued,I shall employ persons Lbiect to workman's com ensa- --tion Imus of California." :The applicant must call for allrewired inspections. Complete drawing on reverse side. �. fa Signed _' .n- _ � t r• p Title' Date: FOR DEPARTMENT USE ONLY j 'Application Accept ed by Date�� Area� — Pit or Grout ins a. y!, pet tion by Date Finallrisp�ctiun by Date rAdditbonal Comments: I ' Stk A&_>-3781 0 Nod's 1 u Manteca 1104 >'-..' Tracy 835-8385 ;Applicant- Return all copies to: Environmental Health Permit/Sernrices 1601 E. Hazelton Ave., P.O. Box 2OW, Stk., CA 55201 FEE 1 IVO AMOUNT DUE � AMOUNT REIMITTEG i PK #tECEIVEL?8Y 1 llA7E 3�E!?vti i N£D. _ C ,SH + £H 4324(REV. 10t831,i i 1 i s i