90-1979 - Laserfiche WebLink

Home Browse Search

ZX y a " APPLICATION FOR PERMIT 'a SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 i PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1 . (Complete in Triplicate) II 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. 186 for well/pump and the Rules and Reg lations of the San Joaquin i Locale Health District.�D - 6I Job Address N W CorneLof City Lot Size PM iI k Owner's Name R RAS T I_ & SONS DA T RY Address Phone238-2268 I ii Contractor HENNINGS BROS. DRILLING Address 3525 PELANDALE AVE. License No. 290813 Phone-545-1 185 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION)([)( PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE p FOUNDATION AGRICULTURE WELL 'OTHER WELL- YITSISUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications �`�} f'1 Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout I I Irrigation -Approx. Depth I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump-I H.P. State Work Done _ u Well Destruction (N Well Diameter ll 10 rt Sealing Material (top 501 RENTONITE i i Depth �5 `�� Filler Material (Below 50') AALg TYPE OF SEPTIC WORK: NEW INSTALLATION t 1 REPAIRIADDITION l I DESTRUCTION l I (No septic system permitted it public sewer is + f� available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Q Character of soil to a depth of 3 feet: Water table depth ^ F SEPTIC TANK ❑ Type/Mfg I Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance td nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line I SEEPAGE PITS l 1 Depth Size Number ,, SUMPS ._ L7flistance_to,,nearest:;_ --Well. _ _-roperty„Linew-oundaon 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. sl 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 became 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 laws of California." !I The applicant must call for all required inspections. Complete drawing on reverse ,side. Signed X mrnAn.a �ll n ate.��i -_�v_� tle:11� r� ��] O rV l'.5�� Date: 1 y `�0 F R Z�;7.11JISE ONLY Application Accepted byDat Arna Pit or Grout Inspection by Date Final Inspection by Date I Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201FEE q INFO AMOUNT DUE AMOUNT REMITTED CK N CASH RECEIVED BY DATE PERMIT'NO. r ♦.EH 13-24{REV.i/n51 EH 1426