SR0085108_SSNL - Laserfiche WebLink

Home Browse Search

Application is helehy•made to the San Joaquin Local Health District for a permit to construct and/of install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1662 for well/pump and the Rules and Regulations o1 the San Joaquin Local Health District. Job Address i�_50tyl f1!Lev�1,�tlGrr� City Lot Size PM Owner's Name � ( Address -199Sb Y1 -i4 , �q . 044!M jz ed— Phone u .:�, - ContractAddress 60,66- 740 r (r> �C _ License No. _ 3�8-ZY-� Phone t TYPE OF WELL/PUMP: ' NEW WELL U WELL REPLACEMENT n DESTRUCTION L' (" PUMP INSTALLATION-, LI SYSTEM REPAIR n - 'OTHER U DISTANCE TO NEAREST: -SEPTIC TANK _ SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION ° AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE, ._r. :.TYPE OF.WELL' PROBLEM AREA CONSTRUCTION SPECIFICATIONS + n Industrial ❑ Open Bottom O Manteca Dia. of Well Excavation Dia. ofjell Casing f_7 Domestic/Private D Gravel Pack ❑ Tracy Type of Casing Specificacens l I'I Publics n Other n Delta Depth of Grout Seal Type of Grout_ I I Irrigation• Approx.•Depth'. 11 Eastern Surface Seal Installed by R'opair•Work Done iJ ' Type of Pump H.P. State'Wurk Done _ Well Destruction Well Diameter; - Sealing'Material (top 50'1 — Depth ! Filler Material Ieolow 501 TYPE OF SEPTIC WORK: {NEW INSTALLATION I 1 DI11ON I I DLSTRUCtION I I (No septic system permitted if public sewer is ,� available within 200 feet.l Installation will serve;, Residence__Commercial —_ Other r� Number of living units ': Nuber mof bedrooms Character o1 soil_to a deptK.bf 3 feet: i}t� _,- . _ Water table depth- SEPTIC epthSEPTIC TANK n Type/Mig Capacity—_ No. Compartments .._.. PKG. TREATMENT PLT. nr . . .Method of Disposal bistance to nearest: WCII Foundation Property Line __..._ .. v LEACHING LINE 14— No. & Length of lines .. ./- _11__.•__ Total length/siie__.p_ FILTER BED U Distance to nearest: ' Well Foundation _ ( Property Line SEEPAGE PITS 1 1 Depth •. _....._ .. ... 'Size `'�Q=n lt�{ SUMPS LR- Distance to nearest: Well._./ P> oundation f Prop" line DISPOSAL PONDS D '• f I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, state•faws, 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 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 cornpensa tinn laws of California." -^ The applicant must all for all required inspections. Complete drawing on reverse siife, r Signed X__ . /J��/�� •..^�i�. Title:�-.moi-�-.l---.--_. .Date: 'FOR DEPARTMEFVT USE ONLY:.p"Iicanepted by ___ tion by Date _�"1% Final Inspection by �(� Date 1 .. Additional Comments: F1 Sik 466.6781. n Lodi 369-3621 D Manteca _ 823.7104 O Tracy 835.6385 Applicant - Return all copies to: Environmental Health Pormit/Servicos 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 . EM 13.24 1REV. l EH 1/.4 1 74 in, APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone (209) 466-6781 AMOUNT DUE PERMIT EXPIRES 1'YEAR FROM DATE ISSUED t " - (Complete in Triplicate) Application is helehy•made to the San Joaquin Local Health District for a permit to construct and/of install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1662 for well/pump and the Rules and Regulations o1 the San Joaquin Local Health District. Job Address i�_50tyl f1!Lev�1,�tlGrr� City Lot Size PM Owner's Name � ( Address -199Sb Y1 -i4 , �q . 044!M jz ed— Phone u .:�, - ContractAddress 60,66- 740 r (r> �C _ License No. _ 3�8-ZY-� Phone t TYPE OF WELL/PUMP: ' NEW WELL U WELL REPLACEMENT n DESTRUCTION L' (" PUMP INSTALLATION-, LI SYSTEM REPAIR n - 'OTHER U DISTANCE TO NEAREST: -SEPTIC TANK _ SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION ° AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE, ._r. :.TYPE OF.WELL' PROBLEM AREA CONSTRUCTION SPECIFICATIONS + n Industrial ❑ Open Bottom O Manteca Dia. of Well Excavation Dia. ofjell Casing f_7 Domestic/Private D Gravel Pack ❑ Tracy Type of Casing Specificacens l I'I Publics n Other n Delta Depth of Grout Seal Type of Grout_ I I Irrigation• Approx.•Depth'. 11 Eastern Surface Seal Installed by R'opair•Work Done iJ ' Type of Pump H.P. State'Wurk Done _ Well Destruction Well Diameter; - Sealing'Material (top 50'1 — Depth ! Filler Material Ieolow 501 TYPE OF SEPTIC WORK: {NEW INSTALLATION I 1 DI11ON I I DLSTRUCtION I I (No septic system permitted if public sewer is ,� available within 200 feet.l Installation will serve;, Residence__Commercial —_ Other r� Number of living units ': Nuber mof bedrooms Character o1 soil_to a deptK.bf 3 feet: i}t� _,- . _ Water table depth- SEPTIC epthSEPTIC TANK n Type/Mig Capacity—_ No. Compartments .._.. PKG. TREATMENT PLT. nr . . .Method of Disposal bistance to nearest: WCII Foundation Property Line __..._ .. v LEACHING LINE 14— No. & Length of lines .. ./- _11__.•__ Total length/siie__.p_ FILTER BED U Distance to nearest: ' Well Foundation _ ( Property Line SEEPAGE PITS 1 1 Depth •. _....._ .. ... 'Size `'�Q=n lt�{ SUMPS LR- Distance to nearest: Well._./ P> oundation f Prop" line DISPOSAL PONDS D '• f I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, state•faws, 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 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 cornpensa tinn laws of California." -^ The applicant must all for all required inspections. Complete drawing on reverse siife, r Signed X__ . /J��/�� •..^�i�. Title:�-.moi-�-.l---.--_. .Date: 'FOR DEPARTMEFVT USE ONLY:.p"Iicanepted by ___ tion by Date _�"1% Final Inspection by �(� Date 1 .. Additional Comments: F1 Sik 466.6781. n Lodi 369-3621 D Manteca _ 823.7104 O Tracy 835.6385 Applicant - Return all copies to: Environmental Health Pormit/Servicos 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 . EM 13.24 1REV. l EH 1/.4 1 74 in, JPJFa AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO.