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88-439
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4200/4300 - Liquid Waste/Water Well Permits
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88-439
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Entry Properties
Last modified
12/14/2019 10:08:42 PM
Creation date
12/4/2017 4:22:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-439
PE
4221
STREET_NUMBER
12
Direction
N
STREET_NAME
CARDINAL
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
12 N CARDINAL AVE
RECEIVED_DATE
3/3/1988
P_LOCATION
N TAFURI
Supplemental fields
FilePath
\MIGRATIONS\C\CARDINAL\12\88-439.PDF
QuestysFileName
88-439
QuestysRecordID
1678439
QuestysRecordType
12
Tags
EHD - Public
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,f <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1'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. 1962 for well/pump and the Rules and Regulations of the San Joaquin i <br /> Local Health District. ! <br /> Job Address . <br /> �o� N • �,44Z> ,,AJ A L City �TK NB Lot Size PM <br /> Phonel!% <br /> /. y <br /> r C'-i Ie�/AMAM �- a�-�� <br /> X Owner's Name 704��� Address N <br /> ` e ,,) ��� 41W License No��"� PhoneV6 5/-F,6 7 a <br /> Con tractof �_6J4q ' Address <br /> TYPE OF WELL/PUMP: NEW WELL ❑ N WELL REPLACEMENT ❑ DESTRUC-TION ❑ <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 /> LJ <br /> PECIFICATIONS❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy - Type of Casing Specifications <br /> [-I Public 0 Other F1 Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation --Approx. Depth I 1 Eastern Surface Seal Installed by - <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50'1 <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION i:I REPAIRIADDITION [ I DESTRUCTION Mo septic system permitted if public sewer is <br /> available within 2001eet.) <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 ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property.Line <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS l I Depth —Size _ Number <br /> SUMPS Cl Distance to nearest: Well 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. <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: "f certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete drawing on reverse side. <br /> X - i� <br /> ' Signed e�+ <br /> Title: c.� � c a^- Date: <br /> n FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date <br /> ^^ Area 10 <br /> Pit or Grout Inspection by Date Final Inspection by / i Date -� <br /> Additional Comments: —SU <br /> ❑ Stk 466-6781 ❑ Lodi 369-3 1 Cl Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. <br /> INFO <br /> 1111 <br /> +.EH 13-24IREV.1/951 e56�' <br /> EH 14-2e v c� <br /> i <br />
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