ARCHIVED REPORTS_XR0007743 - Laserfiche WebLink

Home Browse Search

1:ev v APPLICATION FOR PERMIT OSAN JOAQUIN LOCAL HEALTH DIST 1601 E HAZEL i ON AVE , STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPiRES 1 YEAR FROM DATE ISSUED 1Complete in Triplicate) Application is herehy made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described This application is made in compliance with San Joaquin County Ordinance No 549 for sewage or No 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District Job Address _1�5� I,a111�Si�L�1 -___�1 City SLot Size PM Ownr,r s Name 7IiZLEr!t---a1 t��f?>� Address L� ) L��? tb�JP one —%,Z'"-� Contractor/t � ! �� i se No O Phone G ` TYPE OF WELL/PUMP NEW WELL Eh DESTRUCTION Cl PUMP INSTALLATION 0 SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST SEPTIC TANK ____ — SEWER LINES __._ DISPOSAL FLD AIA PROP LINE $� FOUNDATION _�� AGRICULTURE WELL 4VIk— OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WFLI PROBLEM AREA CONSTRUCTION SPECIFICATIONS (A industrial ❑ Open Bott,)m f_, Manteca Dia of Well Excdvationtt —id t Dia of Well Casing � C1 Domestic/Private ❑ Gravel Pack I 1 Tracy Type of Casing f"I „ T-0 Sc)n& L!D Specifications ��`` ! Public fXl Other I 1 Delta D{.pth of Grout Seal r `Type of Grout 91 rYTf �, 6, Ip�'�— Jr0 Approx Depth I I Edstern Surface Sedl Installed by fLIII it Gf1'► Repair Work Done 1_1 Type of Pump H P _ State Work Done _ Well Destruction ❑ Well Diameter _ Spalinq Material (top 50) Depth Filler Material (Below 50 TYPE OF SEPTIC WORK NEW INSTAL LATION I I fl[I'AIRIADDITION 1 I DESTRUCTION l I (No septic system permitted if public sewer is available within 200 feet 1 • Installation will serve Residence-- Commerc I 011ier Number of living units _ Number of bedroom Character of sod to a depth of 3 feet —_ —_ Z Water table depth SEPTIC TANK L-I Type/Mfg Capacity No Compartments PKG TREATMENT PLT 11 Method of Disposal Distance to nearest W;I — __ Foundation__ Property Line LEACHING LINE C1 No & Length of Imes Total length/size_FILTER BED C) Distance to nearest WFoun tion Property LineSEEPAGE PITS I I Depth __ Number _ SUMPS [ I Distance to nearest Well _ Foundation Property Line DISPOSAL PONDS f 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 Local Health District 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 worleman s compensation laws of California Contractors 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 �II�J� The applica&Scallr all r quired inspections Complete drawing on rave se side sly i(Jt"3}Jk�� C "I _sig _— cit 1, 0 V4'1C4L FOR O RT09MMENT SDate ONLY c Application Accepted by _— Date Area Pit or Grout Inspection by _ ,-�?f/� �� -- Det t��'��' Final Inspection b,, JrJ-rel Date Additional Comments 0 ❑ Stk 466 6781 ❑ Lodi 369 3621 Cl Mentoca 823 7104 ❑ Tracy 835-6385 Applicant Return all copies to Environmental Health Permit/Services 1601 E Hazelton Ave P O Box 2009, Stk , CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO INFO CASH ♦ EH7324{REV tin Sl 1 � 4... � / 5'' EH 14 76 r��