SU0013585 - Laserfiche WebLink

Home Browse Search

Work plan faxed 'to APPLICATION FOR PERMIT E1_nore Ratliff SAN JOAQUIN LOCAL HEALTH DISTRICT 2-21-90 by Nolte & 1601 E. HAZELTON AVE., STOCKTON, CA Assoc . Stephen Kenning Telephone (209) 466-6751 t 4 ,��"`� PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby 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. 18846 N HVT 99 Cit Lodi Lot Size 55 AC PM Job Address - Y — Owner's flame _Ji ctor Fine Foods Address P •0 • Box 147 Lodi, Cal .95 2�l�ne 209--368-5117 Ccrning,Cal . 9 021 ContractorNorth Valley Drill; g., Inc . P.O . Box 108 License No. 41-8834 PhoneQ16-824-01 2 TYPE OF WELL/PUMP: NEW WELL L3WELL REPLACEMENT ❑ DESTRUCTION U PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 6 Monitoring DISTANCE TO NEAREST: SEPTIC.TANK SEWER LINES DISPOSAL FLD._- -PROP. LINE T FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS! '❑.Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 177 __ Dia. of Well Casing n ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Sch 40 PVC Specifications ('I Public ❑ Other ❑ Delta Depth of Grout Seal 10, Type of Grout Ne at c eme n t, I I Irrigation 20tApprox. Depth I i Eastern Surface Seal Installed by cement Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction C Well Diameter Sealing Material (top 501) ;..Monitoring Depth Filler Material IBelow 50') _ —_.. TYPE OF SEPTIC WORK: NEW INSTALLATION-I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer_is available within 200 feet.I 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 DC7-Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. 0 Method of Disposal ^^ Distance to nearest: Well Foundation -Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED- U Distance to nearest: Well _ Foundation __ Property Line _SEEPAGE PITS i,I Depth ___ Size _ Number SUMPS L, Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ • 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 p1wormance 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 taws of California." The applit must call for all requ ctions. Complete drawing one. / Signed X Title: �_ Date: �— b �0 DEP ENT USE ONLY f^, 007 Application Accepted by �y Date �✓ /�' Area 2 Pit or Grout Inspection by 47 It Date Final Inspection by Date Additional Comments: e7_14 12 1 t!� � ❑ Stk 466-6781 ri Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 �. f c� /l(d 7— Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 �y FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. �}�f_A INFO / ' Q/y��7 t.EH1424IREY.r,nbr 3s lg L{ �� o '