ARCHIVED REPORTS_XR0003890 - Laserfiche WebLink

Home Browse Search

f opy SAN JOAQUIN COUNTY PUBLIC REALTH SERVICESpAYMEN :. EN.V I RONMENTAL F#EA LTH DIVISION 445 N SAN JOAQUIN" PHONE (209)468-3420 RECEIVED . P o Bog 2009, STOCKTON, CA' 95201 JAN 19 1993" PERM T EXPIRES ] YEAR k'R M DATE ISSUE�N JOAQUIN COUNTY (Complete in Triplicate) LIC HEALTH SERVICES A lsaatson Se kora ENVIR4NMI=NTALHFALTH DIV1SION pA by made,to Ban Joaquin County for a per to 'aonatruct and/or inst:el-1- the work herein described. This ePpliestion is siade in eonipliAnce with San Joaquin county ordinance No. 549 end 1862 and the Rules and Regulations of San � Joaquin County Public Health Services. j I Job Address 2500 W. Lodi Avenue L.od.i', CA .56 :"Acres City Lot Size/Acreage I owner', Name USA Polroleurn Corp. Address P.O. Box 1839 Santa Monica , CA Phone (310) 452-620 1 Contractor Woodward Dz-illing COAddress P.O. Box 336 , Rio Vista, C 581639 C-5� (707) 374--4 00 t it,r S�No. hone f TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT El DESTRUCTION Cl Out of Service Ne11 Ll PUMP INSTALLATION ❑ SYSTEM REPAIR C1 OTHER ❑ Monitoring Well n I DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER LINES 50' DISPOSAL FLD. PROP. LINE 75' G f FOUNDATION 25 AGRICULTURE WELL 500 OTHER WELL MN 30 PITS/SUMPS NSA 't INTENDED USE TYPE OF WELL. PROBLEM AREA CONSTRUCTION SPECIFICATIONS i Cl industrial 0 Open Bottom .❑ Mamecs Dia. of Well Excavation 8� Die, of Wall Casing 211 { N Domestic/Private M Gravel Pack 0 Tracy." Type of Casing 2" SCSI 40 WC Specifications-S*�e TAbZiCF3lal 1/ /93 l i� t Il Public [ icor l Other FT Delta De T I; th of Grout Seal Neat" OLIMlt w y e l i i P ;" Typo of Grout / � t f Irrlgstion _.'Approxi Depth IN Eastern LCCii Surface Seut Installed by��d U-tile• tOi11t(' } Repair Work Done U Type of Pump N18 H.P. State Work Done Well Destruction ❑ Well Dismalet R8' Scaling Material 4 Depth _Wat- v5a. Beoti,ite - su ,hydratV_Penton to Depth _ 60-'_ Filler Material L Depth 60730' ��M)n1gue Ea ld 29' TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADOtTION I I DESTRUCTION 1:1 tNo septic system permitted if public sower (s available within 200 feet.) } iteflallon will serve: Residenct Commercial — Other '# Number of livino units. Number of bedrooms N/A b I Character of soil to ■ depth of 3 feet: Water table depth ! SEPTIC TANK ❑ Type/Mfg Capacity No. CompartmentS PKO. TREATMENt PLT. 0 Method of Disposal .` Distance to nearest: Well Foundation Property tine 11 TEACHING LINE Ct No. b Length of lines Total length/size FILTER BED EI Distance to nearett: Well Foundation Property Line N/A s SEEPAGE PITS I I Depth Sire Number ` SUMPS L1 Distance to nearest: Well Foundation Property Line l i; DISPOSAL PONDS 0 N/A 3 I hereby certify that I have prepared this application and that the work will be done in accordancewith San Joaquin county ordinances, state taws, and\, rules and regulations of the San Joaquin County A Home owner or licenead agent's Slgnalure certifies the following: "I certify that In the periotmancs of the work for which this permit Is issued. I shat,not employ any person In such manner at to become subject to workmen's compensation laws of California." Contractor's hiring or sub-contracting signaivre certifles the followin¢: "I tartify that in the performance of the work for which this permit Is lstued, 1=shali employ persons subject to workman's compenta• .' tion taws of Csllfomis." The applicant mus for Ire c 0 Complete drawing on reverse side. ~ i ' President 5�stern Gia-I .ineclz"s �� Signed X / — Title: -mat i -tt, td t�ill�-�. r� "� �- Date: l �� FOR DEPARTMENT USE ONLY . Application Accepted by Date IQ - Area ' Pit or Grout Inspection by Date Final Inspection by Date' Itoast Comments; orlicant - Return all copies to: San Joaquin County Public. Health Services _ EnvirOnmentnl flenith Pcrmit/eervicen 445 N San Joaquin, P 0 Box 2009, Stkri, CA 95201 ~'3 y FEE AMOUNT DUE AMOUNT REMITTED i t INFO CASH nECEIVED 9Y DATE PERMIT"NO. F H 11.24 IREV.7rRal ' N 1r.1eN-50 -L;rl 11,�Vo ca -