SU0013225 - Laserfiche WebLink

Home Browse Search

1 1 APPLICATION SAN JOA�UIN COUNTY PUBLICJD15 JVl90 D� $S 130 �(�,y� ffidVIRCIN][�1TAL HEALTH ll9/ - 0 445 N SAN JOAQUIN, PHONE713420j70 P O BO% 2009, STOCKTONFRMIT EXPIR EAR FROM ATW(Complete in TriplApplication is hereby ladeto San Joaquin County for a permit to constre J is application is made In compliance with San Joaquin County Ordinance No. 549 and 1862 and tht ee a Joaquin County Public Health Services. Job Address 865 E Rathl PrI _ Cit yF r a n r h t:a m¢ot Size/acreage , Owner'a Nam.Pa c]-f i C Precast Address -3508 D P t $d H y.v a r.t phone 51 Q-72:2-867 7 Contractor CIark _I�e�l Address_2Z2-&-Z_ Ch arror- — LicenseNo,34J,540 Phone 6 TYPE OF WELL/PUMP: NEW WELIX®xx WELL REPLACEMENT C-1 DESTRUCTION ❑ Out of Service Nell ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR G OTHER O Monitoring Stell C7 DISTANCE TO NEAREST: SEPTIC TANK-t.1 58SEWER LINES DISPOSAL FLO_ PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Ll Industrial G Open Bonom ❑ Manteca Dia. of Well Excavation 16 Dia. of Well Casing 8 tt l Domestic/Private ,Gravel Pack ❑ Tracy Type of Casing-__SSpecifications- I'1 Public I 1 Other F1 De+:a Depth of Grout Seal I Q Type of Grouter e a s 14 - 1 1 Irrivalion ____ Approx. Depth 1 I Eaststn Surface Soul Inslafled by Repair Work Done U Type of Pump S tt h H.P. S State Work Done EL n 19 tc a} Well Destruction ❑ Well Diameter Sealing Material i Depth M Depth Filler Material 1, Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAtRlADOiTI()N f I DESTRUCTION I I (No septic system pefmitlad if public sewer is available within 200 feet.) installation will serve: Residence_„ Commercial`_ Other Number of living units: Number of bedrooms Character of SOW to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG, TREATMENT PLT_ 0 Method of Disposal Distance to nearest: Well . _ Foundation Property Line LEACHING LINE 0 No. 8 Length of Ilnes Total length/size FILTER BED ❑ Distance to nearest= Well Foundation Property Line SEEPAGE PITS 11 Depth Size , Number SUMPS 1.1 Distance to nearest: Wall Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this.Vplicstlon and that the work will be done in accordance with San Jaaquin County ordinances, state laws. and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the lollowing; "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 workmen's compensation laws of California." Contractor's hiring or subcontracting signature certifies the following; "1 certify that in the performance of the work for which this permil Is issued, I shell employ persons subject to wor{trttan's compensa- tion laws of Calilwnis." The applicant II f d!r u ti C plate drawing on reverse side. Signed Title:VP Clark W Date: 18 fi n r t g 3 FOR DEPARTMENT USE ONLY ' I" ,p Application Accepted by A Pit or Grout limpection by pate 1�+o�� Final In � Date � Additional Comments: D % Applt.c�nt - Return all copten to: San Joaquin County Public Health Servicess/ fj7p l�f"o - m Environental Health Permit/Services 0,111, ' M`bb 445 N San Joaquin, p O Box 2009, 3tkn, CA 932D1 049011// 0I FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE AERMIT NO. vn INFO CASH FH 1134 INEV.lixbl ` N �' -73 5*14.21 �.p . 0?/ �r