COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH orrRVICES 7 ENVI RON'1dENTAL HEALTH DIVISION V *'- �'.•,,+ 1601 E. HAZELTON AVE. , PHONE (209)468-34`20 f0 i"L"�z�,, br P O BOX 2009, STOCKTON, CA 95201 p: 4'," `...... PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ic 44 cc/, (Complete in Triplicate) Nrq�y£SES` Application Is hereby made to Sao Joaquin County for a permit to construct and/or install the work herein deSF.ij�be This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and RegulaLloii /w1f San a Joaquin County Public Health Services. Job Address 1130 E MARCH LANE ___ c.ty STOCKTON Lot Site/AcreKee 1.74 ACRES 10357 LOS ALAMITAS BLVD Owner's Name _RALLY'S HAMBURGERS, INC.Address LOS ALAM ITAS__GA_9Q_Z2D_-2110_ Phone (213.) 598-500 3663 OMEC CIRCLE, SUITE 8 Contractor B&F DRILLING _ Address .RANCHO CORDOVA1 CA 95742L•Cense No 519428Phone 916=631-954 TYPE OF WELL/PUMP NEW WELL O WELL REPLACEMENT n DESTRUCTION it Out of Service Well (7 PUMP INSTALLATION O SYSTEM REPAIR C, OTHER Monitoring We g Geotechnical ) of 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 (l Industrial U open Bottom O Manteca Dia. of Well Excavation D.a of Well Casing (I Domestic/Private O Gravel Pack 0 Tracy Type of Casing. ___ Specifications Depth --10'- 1)0 Public II other n Delta Depth of Grout Seal Entire Dep-ft Type of Grout Cement Benti ite I I IrnUat.on __ Approx. Depth I I Eastern Surface Seal Instau„d by Contractor Repair Work Done Type of Pump H.P. State Work Cone Well Destruction 2' Well Diameter Sealing Material i Depth Depth Filler Material i Dept: If JON TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIR/ADDITION 1 1 DESTRUCTION 1 I (No septic system permuted .1 prrbl-C sewer .s available within 200 feet I 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. Companments PKG. TREATMENT PLT. O atiMethod of Disposal Distance to nearest: Well Foundon Property Line LEACHING LINE L1 No. b Length of lines Total length/site FILTER BED CI Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Site 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• an rules and regulations of the San Joaquin County Home owner or licensed agent's sigriaturs certifies the following: -I certify that in the performance of the work for which this permit is issued. 1 shall no employ any person in such manner as to become subject to workman's compensation laws of California."Contractor's hiring or subcontracting 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 st call fo all a u'red inspections. Complete drawing on r arse side. /� f Signed X Title ,e r"� Date: A < FOR EPARTMENT USE ONLY Application Accepted by '° Date ^ Area Pit or Grout Inspection by Data ' ) Final Inspection by 4J G C_ Date Additional Comments: Applicant — Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Razelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CK a RECEIVED BY DATE PERMIT'NO. • EN 13.24(REV.vestQ fx'�9 a EN 14.25 J V ( 1./ /�