FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

..s � . SAN OQUIN COUNTY PUBLIC HEALTH VICES ENVIRONMENTAL HEALTH DIVISI II`'nIJ', 445 N SAN JOAQUIN, PHONE (209)468-3420 9 �/O JJ�jj�NY P O BOX 2009, STOC%TON, CA 95201 JUL 0 1 1993 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Ct' (Complete in Triplicate) ApplicMtl�Vqq/,,�� mg,w4 �an Joaquin County for a permit to construct and/or install the work herein described. This appllcatl0tCRMJ{� Ra10[4liance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 1 1 0 EAST TURNER ROAD City I,('1D,T Lot Size/Acreage Owner's Name LUSTRP..-CAT, Address 110 EAST TURNER Rn T.QDT Phone .114-6961 Contractor 6"drE�f '� D X05 L�� e No. ��' �Pnon u�/5� d TYPE OF WELL/PUMP. NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER Q( oni,�jj�r�ing Well ❑ DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES MA DISPOSAL FLD. NA. PRI Jo art ~�~' FOUNDATION NA AGRICULTURE WELL _11A_ OTHER WELL NA PITS/SUMPS _NA SBS I INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Y ❑ Industrial ❑ Open Bottom ❑ Manteca Die. of Well Excavation Dia. of Well Casing r 1 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications I'1 Public 1"1 Other n Delta Depth of Grout Seal Type of Grout I I Irngabon _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material a Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will ""a: Residence_ Commercial_ Other �+ �- Number of living units: _ Number of bedrooms Q Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest Well Foundation Property Line LEACHING LINE D No. 8 Length of lines Total length/size I FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 I hereby Cenity that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, end rues 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. 1 shall not employ any person in such manner as to become subfect to workman's compensation laws of California."Contractor's hiring or sub-contracting 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 applicants my/"a/lll tar�a,Rlrr uy�/p mspe i omplete drawing on revvss(/�/srtle. �y Signed X_,/� //...�A /�� Title: //�/I-F'� -- Date: —�— / _ FOR DEPARTM'"'' . " ' +Y '� -- - a - _ Area sEZ� Application Accepted by Date_ Y�Ck.(�t�- Pit or Grout Inspection by Date .inst Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE I NFO AMOUNT DOTE AMOUNT 1/REQMI}TTED 1A'CASH RECEIVED BY O-/A/ITE PERMIT'N0. s . EM 14.26(REV.r/eei s' V rOV `� iV� IIVI✓✓ �`(�` 3 • J EN to