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88-242
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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88-242
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Entry Properties
Last modified
12/6/2019 10:41:52 PM
Creation date
12/4/2017 4:21:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-242
PE
4382
STREET_NUMBER
7765
STREET_NAME
CARAN
City
STOCKTON
SITE_LOCATION
7765 CARAN
RECEIVED_DATE
2/4/1988
P_LOCATION
DORIS BANEK
Supplemental fields
FilePath
\MIGRATIONS\C\CARAN\7765\88-242.PDF
QuestysFileName
88-242
QuestysRecordID
1678179
QuestysRecordType
12
Tags
EHD - Public
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7s9G13 <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> A 4Telephone (209) 466-6781 <br /> PERMIT EXPIRES 11,YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> 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 <br /> made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for we11/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. V <br /> Job Address / /4 s- _ - City Lot Size PM <br /> t <br /> Owner's Name _0,� , L Address Phone <br /> Contractor <br /> t" Address L� a` License Not k� Phone'7`G_ 0 D-d <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> R Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications . <br /> 17 Public ❑ Other 11 Delta Depth of Grout Seal Type of Grout <br /> I 1 Irrigation _Approx. Depth I I Eastern Sruface Seal Installed by h - <br /> Repair Work Done ®; Type of.Pump -� H•P r� at,Work-Done _ e �`� <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION i.1 REPAIRIADDITION I I DESTRUCTION l I (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> 'installation will serve: Residence— Commercial--�__ Other- <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: ` Water table depth <br /> SEPTIC TANK 1:1 Type/Mfg i -Capacity k No. Compartments <br /> PKG, TREATMENT PLT. ❑ Method of Disposal <br /> t <br /> Distance to nearest: Well 1 Foundation Property Line <br /> 6 LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to_nearest: Well Foundation Property Line <br /> SEEPAGE PITS I i Depth Size ` Number <br /> SUMPS Ll Distance to nearest: Well i>e Foundation Property Line <br /> DISPOSAL PONDS ❑. <br /> 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 <br /> rules and regulations of the San Joaquin Local Health District. l s <br /> 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 <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> certifies the following: "I certify that in the performance of the work for which this permit is issued, I shalt employ persons subject to workman's compensa- <br /> tion laws of California." s <br /> The applicant st call r all requir , inspections. lomplele drawing on reverse side. / 1 <br /> Signed XDate: <br /> FOR-DEPARTMENT USE ONLY �4 <br /> Application Accepted by Date Area <br /> Pit or Grout inspection by Date Final Inspection by Date <br /> Additional Comments: <br /> `❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 y. ❑ Tracy 835-6385 <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Silk., CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED CA RECEIVED BY DATE PERMIT'NO. <br /> INFO <br /> ry <br /> + EH 13-24 IREV.t/n 51 <br /> EH 16.28 <br />
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