COMPLIANCE INFO_1974-1992 - Laserfiche WebLink

Home Browse Search

'?1W WM APPLICATION FOR-[I-FPMtT SAN JOAQUIN COUNTY PUBLIC REALTH S, VICES ENVTRONM NTAL HEALTH DIVISION 1601 E. HAZELTON AVE., PRONE (209)468-3420 P O BOR 2009, STOCKTON, CA 95201 EXPIRES 1 YEAR FROM DATEIso ED (Complete in Triplicate) Lv� Application is hereby made to San Joaquin County 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 and 1862 and the Rules and Regulations of San Joaquin County Public Health Ser fv oA'c04-94) - e:� yi S r'}r< c'T i n J 5fm-TT4 E ArST" EF Job Address LPODFILL SITE 60 AUST14 RVAD city STb@..KM0 Lot Size/Acreage 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 riot employ any person in such manner as to become subject to workman's compensation Wa , 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 applican st call for all requiredtm0ons. Complete drawing on reverse side. Al Signed X_-_ - Title._!Date:FOR DEPARTMENT USE ONLY Application Accepted by ZAG4G Data `- -- - -- Area Pit or Grout Inspection by __---_-.__ Date _-_ _.- Final Inspection by -e -=Date Additional Comments: t Applicant - Return all copies to: San JOPTOD County Public Health ServicPP, Fnvironmental Health rermtt/Services 1601 F. Razpltnn Ave., P 0 ox 2009 Stockton, CA 95201 EE INFO AMOUNT DUE AMOUNT REMITIrr) RECEIVED RY CIA PERFAIT NO EN 1324 inFv f G Frr 4.>s Z �1 V F2RV/ARD 14C'- Name � P.(7 BU 6336 Srnc�kTot� SZ 4'c!onr�I Sig ' � � � PhoneZOQ �t6`- �1�2 Owner's Address :cl- Contractor_--'pECTVLU�A Address_Z$ZS E. MYRTI"ELicens No. 51�Z-�g Phone -415-%417- l TYPE OF WELL/PUMP: _/- sly( NEW WELLS WELL REPLACEMENT U DESTRUCTION U Out of Service Well U P115) MVJZr,) MW38J PUMP INSTALLATION U SYSTEM REPAIR U I So' 1 Lo","_bTHER OK ��g � ��5 DISTANCE TO NEAREST: SEPTIC TANK -k-5-Q!6 SEWER LINES TIF _�� '_- DISPOSAL FLD7.SDPL PROP. LINE 4U5TtN p,,Vr, 51;JM t51�'1- 14136 FOUNDATION 50-P , AGRICULTURE WELL OTHER WELLADThc.>✓fdrl i iNtP 4�IFt E� INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ?-509 I 1 Industrial L1 Open Bottom f 1 Manteca Dia. of Well Excavation INSNES pia. of Well Casing _ iNcN�S f 1 Domestic/ Private %1'Graval ack Cl Tracy �$AfJD) Type of Casing.S �-IAL--- C .. Specifications _ I'I Public 1 1 Other f 1 Delta Depth of Grout Seal Type of Grout 5 t;FH)_NJ7 e _ I I Irrigation _. _ Approx. Depth I I Eastern p E Surface Seal Installed by s crp- 0 P Repair Work Done (I Type of Pump N H.P. _______..___.._______.__- _ -_.._ State Work Doe --.,_S_ - el tNtt SuRFhtL io We 'M' bestruction O WellDiameterSealing Material & Depth C.E.ME14T� t3ErtTb VNI-ViDJ IN 1 ptfi -95 FEST' Filler Material & D-pth w'T 1N 5f F+_I— F h/E-L 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 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 CapacityNo. Compartments PKG. TREATMENT PLT. U Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE La No. & Length of lines _--_____ Total FILTER RED CI Distance to nearest: Well -_-_-___-- Foundation Property Line SEEPAGE PITS I I Depth _ _ 5i7e -Number SUMPS (_I Distance to nearest: Well _. Foundation _--, Property Line DISPOSAL PONDS U 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 riot employ any person in such manner as to become subject to workman's compensation Wa , 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 applican st call for all requiredtm0ons. Complete drawing on reverse side. Al Signed X_-_ - Title._!Date:FOR DEPARTMENT USE ONLY Application Accepted by ZAG4G Data `- -- - -- Area Pit or Grout Inspection by __---_-.__ Date _-_ _.- Final Inspection by -e -=Date Additional Comments: t Applicant - Return all copies to: San JOPTOD County Public Health ServicPP, Fnvironmental Health rermtt/Services 1601 F. Razpltnn Ave., P 0 ox 2009 Stockton, CA 95201 EE INFO AMOUNT DUE AMOUNT REMITIrr) RECEIVED RY CIA PERFAIT NO EN 1324 inFv f G Frr 4.>s Z �1 V