91-0540 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

Y APPLICATION FOR PERMIT x 45 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION p �.+ 1601 E. HAZELTON AVE. , PHONE (209)468-3420 rd � P O BOR 2009, STOCKTON, CA 95201 R$ IT EXPIRES 1 YEAR FROM DATE 15SUED omplete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. chis application is made in compliance with Ban Joaquin County Ordinance No. 549 and 3862 and the Rules and Regulations of San Joaquin County Public Health Services. Near Thornton Job Address New Hope Tract City LENJI Lot Size/Acreage Towne, Ishizuka, Blossom, ; Owner's Name Goldman & Fontes Address`. _As per attached map ($Pne 05) 324 0405 Western Geophysical Co. P. O. Box 37.7, Bakersfield, Ca. 93302 Same Contractor Address License No, Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 0 DESTRUCTION ❑ Out of Service Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ QTNER yg Monitoring Well DISTANCE TO NEAREST; SEPTIC TANK SEWER LINES DISPOSAL FLD. LTe OpPR�OP. INP FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 1-1 Domestic/Private ❑ Gravel Pack Cl Tracy Type of Casing Specifications F] Public IXl Other CxDeita Depth of Grout Seal Type of Grout I I irrigation 20-L Approx. Depth l I Eastern Surface Seal Installed by Repair Work Done L3 Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material & Depth Chip Bentonl. ce O rOm Depth Filler Material & Depth surface-Then soil TYPE OF SEPTIC WORK: NEW INSTALLATION I ) REPAIR/ADDITION ! I DESTRUCTION i I lNo 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. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest; Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line d SEEPAGE PITS I k Depth Size Number C SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ a I 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 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 must call r r ed btions. Complete drawing on reverse side. Signed X Title: Permit Agent Date: 03-07-91 R R. E. Buie FOR DEWTMENT USE ONLY Application Accepted by Date �� Area Pit or Grout Inspection by Date Final Inspection by D a f 2,'l� Additional Comments: ` � z Z�l �`� a aItr \�� iu (a .( �. 6R_\1a_t ,z Applicant — Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE INFO AMOUNT DUE AMOUNT /NREMIITTED A RECCKAL EIVED BY DATE PERMIT NO. + EH 13-24(AEY,r/hs) EH :4-2E