FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT AN JOAQUiN LOCAL HEALTH DISTMi t' 1501 E. HAZEL T ON AVE., S OCKTON, CA Telephone 12091466-67811 PERMIT EXPIRES 11-YEAR FR M DATE ISSUED (Complete in Tripli ate) Application is hereby made to the San Joaquin Local Health District for a permit to c nstruct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 11,62 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. gee Job Address 600-' CRY II orf i� CA Lot Size PM Owner's Name ARCO Products Company Address P" Phondl Contractor Wayne Drilling AddressP Lincoln License No.37FiQ5-Phone 916-965-91 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM RE AIR ❑ one baron OTHER ,X1 soil boring . DISTANCE TO NEAREST; SEPTIC TANK 54� � SEWER LINES ? DISPOSAL FLD� PROP. UNE>19D— eet FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private 0 Gravel Pack ❑ Tracy Type of Casing Specifications f'1 Public n Other Cl Delta Depth of Grout Seat Type of Grouts emen bento to I i Irrigation —.Approx. Depth I I Eastern Surface Seal Installed by slum Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 50) Depth Filler Material (Below 50) TYPE OF SEPTIC WORK: NEW INSTALLATION I f REPAIR/ADDITION l I DESTRUCTION I I (No septic system permitted if public sewer is v available within 200 feet./ Installation will serve: Residence_ Commercial_ Other ` Number of living units: Number of bedrooms 1 Character of soil to a depth of 3 feet: Water table depth ` SEPTIC TANK ❑ Type/Mfg Capac ty No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal . Distance to nearest: Well Foundation Property Line LEACHING UNE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Welt Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS ❑ 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 ir accordance with San Joaquin county ordinances, state laws, and rules and regulations df 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 aws of California."Contractor's hiring or sub-contracting signature certifies the following:"I certify that in the performance of the work for which this porn it is issued, I shall employ persons subject to workman's compensa- tion laws of California." The applicant must call for all required inspections. Co ptete drawing on reverse Sid Signed x_ Eloise K. Frick ' Title; PrDect Gtoloclist Date; 9-11-90 FQfTTEPAR US ONLY / Application Accepted by Date Pit or Grout Inspection by bate Final Inspection t Date Additional Comments: 0 Stk 466-6781 ❑ Lodi 359-3621 ❑ Manteca 923-7104 ❑ Trac 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazel on Ave., P.D. 86-x 2009, Stk., CA 95201 FEE INFO AMOUNT DUE AMOUNT /R'EMITTED CASH RECEIVED BY DATE PERMIT'NO. 13 24• I4-24IREV.I/n5)