90-2065 - Laserfiche WebLink

Home Browse Search

C APPLICATION FOR PERMIT RETURN PERMIT TO: � ' RANEY GEOTECHNICAL SAN JOAQUIN COUNTY PUBLIC, HEALTH SERVICES Attn: Randy Grant I ENVIRONMENTAL HEALTH DIVISION 3176 Industrial Blvd, 1601 E. HAZELTON AVE. , PHONE (209)468-3420 W. Sacramento, CA 95691 P O BOX 2009, STOCKTON, CA 95201 APN: 092-070-14 (916)371-0434 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 366V C. (Complete in Triplicate) Application is hereby made to San Joaquin County 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 and 1862 and the Rules and Regulations of San Joaquin Count Public Health Services. Proposed La Morada Elementary School Job AddressCity Lndi Lot Size/Acreage 11.6 Acres Lodi UniEie 1300 West Lodi Avenue Owner's Name School District Address Phone 209 331-7217 3663 Omec. Circle, Suite 8 Contractor B&F Drilling Co, , Ine tidress 2=cho Cordova CA 95742License No. 519428 Phone(916)631-954 TYPE OF WELL/PUMP: NEW WELL © WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION 0 SYSTEM REPAIR ❑ OTHER X Monitoring well ❑ DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER LINES N/A DISPOSAL FLD, N/A PROP. LINE N/A FOUNDATION N A AGRICULTURE WELL N/A OTHER WELL N � PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing D Domestic/Private ❑ Gravel Pack L7 Tracy Type of Casing Specifications I'i Public El Other fl Delta Depth of Grout Seal Type of Grout I I Irrigation , Approx. Depth I I Eastern Surface Seal Installed by O Repair Work Done U Type of Pump H.P. State Work Done,. Well Desfru on ❑ B�ameter 711 +_ Sealing Material ✓E Depth Cement or bentonite grout i 0 Geotechnxcly - _ exp Depth Varies 5t to 25'Filler Material & Depth groundwater encountered TYPE OF SEPTIC WO K: NEW INSTALLATION [ I REPAIR/ADDITION 1-1 DESTRUCTION I I (No septic system permitted if public sewer is '11 available within 200 feet.) ° V 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 ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT, ❑ Method of Disposal Distance to nearest: Well Foundation Property Line fff LEACHING LINE Cl No. & Length of lines Total length/size FILTER BED 1-1 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS GI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS p 1 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 County 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 compensa- tion laws of California." The applicant must tail for all required inspections. Complete drawing on reverse side. Signed Title: Project Engineer Date: $/2/90 i FOR RANEY GEOTEC ICAL FO DEPARTMENT USE ONLY f Application Accepted by �}Date ! o Area / Pit or Grout inspection by Date Final Inspection by Data B 91Io eko Additional Comments: u ©oje red Z S t �o t _Z ' Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave.ePBox 2009, Stockton, CA 95201 FEE AMDUNT ptJf OUNT REMITTEDRECEIVED BYINFO DATE PERmr'No. EFt 13-21 tREV,rwo .-2e , , r /%