Laserfiche WebLink
- ..._- .-...-._...... ...�.-......._-......r.�r�ri,.r��'�'r 1,i4': � _.•.+-+•_-._..__- 'r <br /> APPLICATION FOR PERMIT <br /> SAN JOAOUIN LOCAL HEALTH DiSTRi:T 0 <br /> 1601 E. HAZELTON AVE., STOCKTON, CA PERMIT 40. 0 <br /> telephone (209) 466.6781 PATE ISSUED 3 <br /> PERMIT EXPIRES I YEAR FROM DATE 1SSULD <br /> (J.nmpletp in Triplicate) <br /> ­ by "ede to tae San Joaquin Local Health District for a permit to construct and/or install the work herein <br /> nnlic.ation is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump <br /> r o'egalations the San Joaquin Local Health District. <br /> ..; _Ljl �_ Subdivision Name <br /> 1✓ Address _S/_..c L Phone <br /> +^nyl l i cense No. _ Z�Z Z-(, _ Phone 15�10 S/O ..r_ � AA <br /> ';i7FTc3Ex' W <br /> /2" p WORK: NEW WELL F_� WELL REPLACEMENT E] DESTRUCTION W <br /> PUMP INSTALLATION SYSTEM REPAIR C] OTHER EJ <br /> '(tARESi_: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE tJv <br /> _ FOUNDATION AGRICULTURE WELL OTHER WELL PITS/Stm <br /> 'P:n USE TYPE O WELL PROBLEM AREA CONSTRUCTION SPECIFICATiONS �J ` <br /> L)6pen Rattom Mr.,teca Dia. of Well Excavation <br /> '••:/Private F`*;Gravel Pack Tracy Dia. of Well Casing <br /> `j Other Delta <br /> -inn Type of Casing <br /> _ Approx. J Eastern Specifications <br /> Protecti". Depth <br /> Depth of Grout Seal <br /> Type of Grout <br /> Surface Seal Installed by ^� <br /> Ione ❑ Type of Pump H.D. State Work Done <br /> —action 0 Well Dianw-ter Sealing Material (top 50') <br /> Depth Filler Material (Below 501) <br /> SEPTIC WORK: NE+ iNSTALLATIOA U, REPAAADDITION 0 (No septic tank or seepage pit permitted if public sewer is <br /> available within 200 feet.) <br /> illation will serve: Residence �i Commnercial _ Other <br /> -'"I of living emits: _-L Number of D rooms 3 Lot size �r,(t��� <br /> -.:cter of sail to a depth of 3 f Q�7{jlj",.-, Water table depth mAL _ <br /> ! TANK Type/Mfg *A_I_, Q.c capacity JVrr No. Compartments <br /> TREATMENT PLT. n Type/Mfg _ Capacity Nethed of Disposal <br /> Distance to nearest: Well ( Foundation Property Line <br /> tNG LIN£ ' No. 6 Length of lines Z --t 7V40 t_f Total length;size —7 Ll_­­ 2-- <br /> BED <br /> BED ❑ Distance to nearest: Well C -Foundation L q Property Line r�� <br /> F PITS Depth — Size A � iumber ` <br /> El Distance to nearest: Well Foundation Property Lina <br /> "?SAI- PON4$ <br /> 1 her-by certify that I have prepared this application and that the work will be done in accorda^-e with San Joaquin county <br /> t­d�nances, state laws, and rules and regulations of the San Joaquin Local Health District. <br /> owneror licensed agent's signature certifies the following: "I certify that in the performance the work for which this <br /> t. is isr.ued. i shall not employ any person in such manner as to become subject to workmn4 commpeh. 'on laws of California" <br /> '-actor's hiring or sub-contracting signature certifies the following: "I certify that in the perfoi'sznce of the work for which <br /> -rmtt is issued, i shad employ persons subject to workman's comipensation laws of California., <br /> • lir� A must cal r 1 required inspections. Complete drawing pn worst side. �j., <br /> , — Title: _ Oete4���� <br /> FOR DEPARTMENT USF ONLY 7Vr''�"�' <br /> 1 . tion Accepted by Area Stk 466-6781 <br /> rinnal Cnmmneuts: �'_ lrY; ll�' Lodi 369-3621 <br /> r grout inspection D Dote Manteca 823-7104 <br /> ln"PectIon by 1.1,." , Date 0 Tracy 835-6385 <br /> Kjrn all copiesL o: t. ironmental Health Permit/Services I 1 E. Ava.. P.O. Boa 2009. Stk.. CA 95201 <br /> "! AMIHINT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. <br /> 10/82 Soo <br />