SU0013585 - Laserfiche WebLink

Home Browse Search

Work plan faxed ,to APPLICATION FOR PERMIT Elnore Ratliff' SAN JOAQUIN LOCAL HEALTH DISTRICT 2-21--90 by Nolte & 1601 E. HAZELi ON AVE., STOCKTON, CA Assoc . Stephen Kenning Telephone (209) 466-6751 tO — 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. C] Job Address __ 18345 N HVff 99 City Lodi Lot Size 55 AC PM Owner's Name 'JT-ctor Fine Foods Address P .O . Boy: 147 Lodi, Cal .95200ne 209-368-5117 Ccrning,Ca1. . 9 021 ContractorL orth Valley grill ,rs, Inc . P .C . Box 108 License No. 3834 Phoneal�—H2'�—01 2 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER t� Monitoring DISTANCE TO NEAREST: SEPTIC.TANK SEWER LINES DISPOSAL FLD._ -PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS `❑.Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation _ Dia. of Well Casing 4tt ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing SCh 40 PVC Specifications f'1 Public F i Other (1 Delta Depth of Grout Seal lO t Type of Grout Ne at C em6 il t, I I Irrigation ZCtApprox. Depth 1 i Eastern Surface Seal Installed by Cement Repair Work Done ❑ Type of Pump H.P, State Work Done Well Destruction ❑ Well Diameter Sealing Material ftop 50') —r -_Monitoring Depth Filler Material (Below 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.! Installation will serve: Residence_ Commercial— Other Number of living units: Number of bedrooms Characte of soil to a-depth of 3 feet: Water table depth 5 EPTIC TANK lw(3-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 r FILTER BED- ❑ Distance to nearest: Well Foundation Property Line 1 _SEEPAGE PITS 4,1 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 Dibtrict. Home owher or licensed agent's signature certifies the following: -1 certify that in the pe jformance of the work for which this permit is issued, 1 shatl not employ any person in such manner as to become subject to workman'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, !.shall employ persons subject to workman's compensa tion Laws of California." The applit must call for all requ ctions. Complete drawing on rse side. /) Signed X Title: Date: �! b V_ _ R DEP ENT USE ONLY Application Accepted by Date �✓ Z��/G Area �� Z Pit or Grout Inspection by e7k At Date Final Inspection by Date Additional Comments: a ❑ Stk 466-6781 F1 Lodi 369-3621 ❑ Manteca 623-7104 ❑ Tracy 835-6385 f cj /1(d Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazehon Ave., P.O. Box 2009, Stk., CA 95201 G� FEE AMOUNT DUE AMOUNT REMITTED t RECEIVED BY GATE PERMIT NO. _A !NFOEH 3-24 / J r.EH 14-215IAEY.i/n 51 �+ �.Z.�l O �'1 4,< G