ARCHIVED REPORTS_XR0008499 - Laserfiche WebLink

Home Browse Search

A_uPLIC 1 I'tON SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION , 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 HERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application to hereby made to San Joaquin County for a permit to construct and/or inatall the work herein described. This ■pplication in made in cam dance with Sae Joaquin County Ordinance No 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 2517--Waterloo Ruad City Srnkrnn_ Lot Size/Acreage 12.8()Q-sq. FI-_ Owners Name E-Z Serve Managemnt Co. Address P.O. Box _922021,Houston.TX 772912h*ne 7 - -4380 Omec Circle Contractor B&F Drilling Address Rancho Cordova, CA 95741,ceme No 519428 Phone 916-631-954 T`r PE OF WELL/PUMP NEW WELL WELL REPLACEMENT n DESTRUCTION L- Out of service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST SEPTIC TANK SEWER LINES DISPOSAL FLD PROP LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS IfITENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS (1 industrial ❑ Open Bottom ❑ Manteca Daa of Weil Excavation Dia of Well Casting i' C 1 Domestic/Private IXGravel Pack 0 Tracy Type of Casing pvc Specifications-5s;h--40 1 1 Public f 1 Other 171 Delta De th of Grout Seat 68 i a Type of Grotfl Cement I I IrrtuaUon —Approxi Depth I I Eastern Surface Seui lnstailrld by Trimme Pepair Work Done L7 Type of Pump H P State Work Done, Well Destruction ❑ Well Diameter Sealing Material i Depth f'121110-OL r n RA-02-On-1 ra Vogl - 68' Depth Filler Material i Depth Silica sand filter Pack - 70' TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIR/ADDITION I t DESTRUCTION I I INa septic system permitted d public sewer is available within 200 test I Installation wtA Residence _ Commercial_ Other Number of kwng units Number of bedrooms Character of W81 to a depth o Water table depth SEPTIC TANK 0 Type/Mfg Ca No Compartments PKG TREATMENT PLT ❑ Method of Disposal Distance to nearest Well o n Property line r LEACHING LINE Ll No & Length nos Total len e FILTER BED ❑ Distanc nearest Well Foundation Property Lint: SEEPAGE PITSDepth Size Number SUMPS L1 Distance to nearest Well __ Foundation Property Line DISPOSAL PONDS ❑ l 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 i signature certifies the following I certify that in the performance of the work for which this permit is issued t 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 fallowing 'I certify that inihe performance of the work lo►which this permit is issued, I shall employ persons subject to workman s compensa non laws of California " The app9icaric-m-tiat tali for all required'inspecttons Complete drawing on reverse side Signed Title Date ',�FOfjr DEPIt,FITMEIVT USE ONLY Q N Apphoatlon Acceptrd by rV�V�1Nf!�,/�[[�L\f Date Area I'M Pit or Grout Inspection by Date Final 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 O Box 2009, Stkn, CA 95201 VVV S INFO AMOUNT DUE AMOUNT REMITTED [ASN RECEIVED BY DATE PERlNIT NO �