92-3413 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application Is hereby made,to San Joaquin County for a permit to construct and/or install the work herein described. This application Is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 10661 GRAVES City__MA N T E C A Lot Size/Acreage Owner's Name HILLARY HAWARTMANT Address 71 14 E. WOODWARD RD. Phone 239-9428 Contiactor HENNINGS BROS.',DRILL.Address 3525 PELAND.ALE AVE . t_icense No. 290813 Phone 545-1185 TYPE OF WELL/PUMP: " NEW WELL WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER p Monitoring Well L7 DISTANCE TO NEAREST: SEPTIC TANK 12 0 t — SEWER LINES 12 0 t DISPOSAL FLD. PROP, LINE FOUNDATION _ AGRICULTURE WELL OTHER WELL PITS/SUMPS I� r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial ❑ Open Bottom (?fl Manteca Dia, of Well Excavation Dia. of Well Casing 611 CLQ Domestic/Private X1 Gravel Pack ❑ Tracy Type of Casing_ Wi :::— Il Specifications Public C7 ther Cl Delta Depth of Grout SeaType of Grout RFNTf)NT T F y ,� NGS EROS D I N11 Irrigation / /[pprox, Depth t I Eastern Surface Seal Installe Repair Work Done L7 Type of Pump I H.P, State Work Done Welt Destruction ❑ Well Diameter r Sealing Materia]. & Depth Depth, - I Filler Material & Depth a TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADOITION-FI DESTRUCTION I I (No septic system permitted if public sewer is f available within 200 feet.l Installation will`servei Residence'] (Commercial— Other Number of living units: Number of bedrooms Character of.sotl to�a!depth.of 3 feet: i. Water table depth SEPTIC TANK. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE CI No. & Length of lines Total length/size L FILTER BED C7 Distance to nearest: Well Foundation Property Line SEEPAGE PITS II Depth Size Number N O N j E SUMPS UI Distance to nearest: Well Foundation Property Line 1> 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 County 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 all required inspections. Complete drawing on reverse side. Signed x ��su�1.n .A 5.,� tla: Date: _OCT. 7 . 1992 OR DEPAR NT USE ONLY [� Application Accepted by Date A a ��--1 16 Pit or rout nspection by. Date Final Inspection Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Sery s �� j4=Rri Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 fEE AMOUNT DUE AMOUNT REMITTED SH CEIVEO OAT PERMIT'NO. INFO . EN 1]•24IREV.1/ 5) , 7 CH 14.2a /r P