COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

gDpLIC_{TT()N SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 Y SAN JOAQUIN, PHONE (209)468-3420 P 0 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. _ _ �Cazi % acres /�/'t d�s�-rr,� Lot Size/Acreage City ccr,facf �cb-err� Job Address (i[�C/ 3.1r Address rCLt?C% ��2Ct �f�Lle Z61L'Phone(Z09)X44-ES 30 Owner's Name L/L CcrrI,rc-T: ic," Dza / bCa1I l cU1Q/ t qG6�S4 / . C Contractor Vre-�i. ST<Il1 I�' Address 2-75� j�'°act Q� �` �1 License No. -5,)� I L Phone lf�l `��- � TYPE OF WELL NEW WELL WELL REPLACEMENT 7 DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR a OTHERgr3c'•R Moni_toriag Well C7 /Nv5C31-��r��'cYt,'Iv ll DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES 3�c DISPOSAL FLO.�' PROP. LINE FOUNDATION xG / AGRICULTURE WELL 7-'�Oo OTHER WELL ` PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial ❑ Open Bottom Manteca Dia. of Well Excavation Dia. of Well Casing F Domestic/Private ❑ Gravel Pack Tracy Type of Casing_ Specifications F1 Public A other gprr;ry %. Delta Depth of Grout Seal Type of Grout I 1 Irrigation �Approx. Depth I ! Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter ' Sealing Material 6 Depth Depth r Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION ': i REPAIR/AOOITION I I DESTRUCTION I i (No septic system permitted it public sower is V available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number of living units: Number of bedrooms C Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of :fines Total length/size FILTER BED ❑ Distance to nearest; Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearssr Well Foundation Property Line \ DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this applicanon and that the work will be done in accordance with San Joaquin County ordinances, state laws, and _ rules and regulations of the San Joaquin Count? C 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 man or as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature C certifies the following: "I certi that in thespe"TiTiplete of the work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of Califor The applicant t call 11 r ui ed i drawing on reverse std Signed Title: VS7 Date: FOR DEPARTMENT USE ONL 7 Application Accepted by Data L Area p Pit or Grout Inspection by Date Final Inspection by �- Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services z Hnvironmental Health Permit/Services J 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK S CASH RECEIVED BY DATE PERMIT NO. INFO��77 (7,q E Kn9 ^ • EH 13.24(REV.t/NSI D 44 lJ /' EH 14.26