COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

APPLICATION SAN JOAQUIN COUNTY PUBLIC SERVICES ar_ ENVIRONMENTAL HEALTH D --- 445 N SAN JOAQUIN, PHONE ( 8-3420 Ll P O BOX 2009 STOCKTO CC ( 520T l�------ PERMIT EXPIRES 1 YEAR FR MI DOtoo-No (Complete in Trip iiW# '7S-/q Application is hereby made.to San Joaquin County for a permit to constr ��VV YY 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. P W 6—1 4 9 Job Address 16777 C H o i,r l a p el City T a t h r o n Lot Size/Acreage Owner's Name Tr P a T e k C r a q -- A oar,n t_.!ddress 2]Q 1 F _ Hammer Phone 472 2020 Contractor Cl ark WP1 1 Address 7(124 F C'hartPr W c License No 560 Phone 462-7676 TYPE OF WELL/PUMP. NEW WELL ❑ WELL REPLACEMENT#q DESTRUCTIO._ '2t of Service Well ❑ PUMP INSTALLATION G SYSTEM REPAIR ❑ OTHER O Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS () Industrial ❑ Open Bottom O Manteca Dia. of Well Excavation rte_ Dia. of Well Casinq[i tt C.l Domestic/Private x(2)Gravel Pack L7 Tracy Type of Casing__St P a 1 Specifications N w 1 2 I'I Public 1-1 Other (_1 Delta Depth of Grout Seal Type of Grout Q s A r h c Q I I Irrigation __ Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H.P. ___ State Work Done _ Well Destruction ❑ Well Diameter - Sealing Material & Depth 9 sack Depth _ Filler-Material & Depth 5�q p d & S o-m tc P k TYPE OF SEPTIC WORK. NEW INSTALLATION i I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence__ Commercial _ Other Number of living units: Number of bedrooms 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 O No. & Length of lines Total length/size FILTER BED Cl Distance to nearest: Well _ Founaation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O 1 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 i e 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 s call r at e u e ns on Complete drawing on reverse side. Signed X Title: VP Clark W ell Date:16 Feb 94 F R DEPARTMENT USE ONLY ` ¢ Application Accepted by � _ Date "2_/ Area Pit or Grout Inspection by _ Date Final Inspection b � � Dates Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOU INFO NT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. Md E3 • EH 13-24(REV.rin5r EH 14.26