My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
FIELD DOCUMENTS
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
F
>
4 (STATE ROUTE 4)
>
17750
>
2900 - Site Mitigation Program
>
PR0501477
>
FIELD DOCUMENTS
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/20/2024 9:09:21 AM
Creation date
1/24/2020 2:24:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0501477
PE
2965
FACILITY_ID
FA0005116
FACILITY_NAME
SMS BRINERS INC
STREET_NUMBER
17750
Direction
E
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95206
APN
18314010
CURRENT_STATUS
01
SITE_LOCATION
17750 E HWY 4
P_LOCATION
99
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
63
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
< .Vtt1[N1 3 <br /> APPLICATION FOR PERMIT `1 I b g I' l-0 109 <br /> t%N JOAQUIN LOCAL HEALTH DISTRIC`.W-' <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES TYEAR FROM DATE ISSUED <br /> (Complete in Triplicate) _ <br /> /W instan the work herein <br /> .This <br /> mapApple in is here <br /> by wcation is <br /> ith San Joaquin nJoaquin Counry ordinance No.50.9 for alth District fsewagor a pe of INo. 1862 fort to c valll1pump and the Rules and Regulations of the Sao Joaquin <br /> Local Health District. <br /> n t'i C>\}N t4�( � City a12x.VLT01� Lot Size N 2 AC�t+ PM <br /> Job Address 17 7`J _8S"� <br /> c �` .� �Zntil�1Z5 _ Address <br /> GI4st" I-ft, 1' tAa/ H Phone �9 94 <br /> owner's Name =_----= 'aw-p <br /> s_a� nit 50`—k�i A 4��_ O License No.C�-28�310 phone -5m�) <br /> A �� .�v+1 � <br /> Contractor Address <br /> TYPE OF WELL/R�: NEW WELL . WELL REPLACEMENT 011 RUCTION ❑ I-Aosst'tetC.oG 1/ � <br /> PSYSTEM REPAIR ❑ <br /> OTHER <br /> UMP INSTALLATION ❑ <br /> SEWER LINES DISPOSAL FLD. PROP. LINE — <br /> DISTANCE TO NEAREST: SEPTIC TANK PITS/SUMPS ._ <br /> FOUNDATION AGRICULTURE WELL OTHER WELL <br /> INTENDED USE TYPE OF WELL BotPROBLEM AREA CONSTRUCTION SPECIFICATIONSDia. of Well Excavation G Dia. of Well Casing 2 1�• <br /> ❑ Open tom ❑ Manteca <br /> ❑ Industrial - .,,,t T of Casing -11t rt i - Specifications <br /> '4 Bills 00 /Private *Gravel Pack ❑Tracy Ep$'�-g' Type of Grout�T�Li'`r33T <br /> ❑ Othgr ❑ Oelta Depth of Grout Seal <br /> FI Public ..'J,...J._--'- NcV E-�S wo.l}RttL IDy _ <br /> I I irrigation ( IepAPWox. Depth I I Eastern Surfs" Seal Inst albd by <br /> H.P. State Work Done_ <br /> Repair Work Dorm ❑ Type of Pump _ \ <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 -J <br /> Depth Filter Material (Below 50'1 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1 1 REPAIR/ADDITION I I DESTRUCTION I I afva(lableo wptt'whhin system permtreated if public sewer is <br /> Installation will serve: Residence— Commercial— Other \ ' <br /> Number of living __units: Number of bedrooms <br /> - - Water table depth <br /> Character of soil to a depth of 3 feet: No. Compartments <br /> SEPTIC TANK ❑ Type/Mfg Capacity <br /> Method of Disposal <br /> PKG. TREATMENT PLT.❑ <br /> Distance to nearest: Well Foundation Property Line - <br /> LEACHING LINE ❑ No. 8 Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> ,:.SEEPAG_E PITS..- <br /> Number <br /> I I Depth., Y-SIw,: . <br /> SUMPS Ll Distance to nearest: Well Foundation_ Property Line _ <br /> DISPOSAL PONDS n <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 /> rut"and regulations of the San Joaquin Local Health District. <br /> certify that in the performance of the work for which this permit is issued, I shall not <br /> Home owner or licensed agent's signature Wnif'ms the following: "I <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractors hiring or sub-contracting Signature <br /> certifies the following: "I certify that in the per armance of the for which t �e per/nit is iu ed, I n ���nil ubject to worms n's� rasa 9 <br /> tion laws of Caliiornia." 6/ }�N r <br /> The applicant must call for all requir spections. Complete drawing on reverse side. / O'AV <br /> ct..y/ Title: `��/�•r/.r _ it Date: PI o�- ®� <br /> Signed., �" <br /> FOR PARTMENT USE ONLY <br /> Application Accepted by <br /> Date 4—P?-4l Aree SJO <br /> ,` 3- IX <br /> b-3— 0 mal Inspection by �` Data <br /> Pit or Grout Inspection by �K Date� � <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 3833821 ❑ Manteca 823-7109 ❑ Trac1 8356385 . <br /> Applicant - Return all copies to' Ernyif omen I Ith Permit Servnces IBO He �n'A�v�e�P.O. ox 2009 5tk CA 9520 <br /> FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATED PERMIT-NO. <br /> —��D 7 (f7—z,,2/9Y- <br /> . EN 3.24(REV.ons, INFO � b /Y•7�r—.f <br /> EH ;4 M <br /> Z <br />
The URL can be used to link to this page
Your browser does not support the video tag.