My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
89-51
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CARDINAL
>
415
>
4200/4300 - Liquid Waste/Water Well Permits
>
89-51
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/8/2020 10:12:01 PM
Creation date
12/4/2017 4:25:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-51
STREET_NUMBER
415
Direction
S
STREET_NAME
CARDINAL
City
STOCKTON
SITE_LOCATION
415 S CARDINAL
RECEIVED_DATE
01/09/1989
P_LOCATION
BEN LEWIS
Supplemental fields
FilePath
\MIGRATIONS\C\CARDINAL\415\89-51.PDF
QuestysFileName
89-51
QuestysRecordID
1678664
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
g APPLICATION FOR PERMIT `( (r—) � <br /> n* SAN JOAQUIN LOCAL HEALTH DISTRICT f„ <br /> i 1601 E. HAZELTON AVE., STOCKTON, CA {� <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSIOM �J <br /> (Complete in Triplicate) 1 <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.548 for sewage or Na. 1862 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. <br /> Job Address S_ J" r" f� � City Lot Size PM <br /> Owner's Name �.s�'�� F � �'`� I�5 Address 1 �5 'sa c4+;fJ! Phone if 3 <br /> Contractor Address ����'� �? License No. Phone_ <br /> TYPE OF WELL/PUMP: NEW WELL Ll WELL REPLACEMENT EJ DESTRUCTION ❑ <br /> lNSTA�LLATION-0 SYSTEM=REPAIR.❑ OTHER-CC]---*- --- -a- <br /> DISTANCE TO NEAREST: SEPTIC TA SEWER LINES DISP <br /> OS LINE <br /> FOUNDATION RICUi TU OTHER-WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL I I AREA UCTION SPECIFICATIONS <br /> ❑ Industrial ❑ O om 11 Manteca Dia. of Well Exc Dia. of Well Casing <br /> ❑ Domestic/Private Gravel Pack ❑ Tracy Type of Casing Specifications <br /> f'1 Public f7 Other n Delta Depth of Grout Seal 'F of Grout �. <br /> I I Irrig, t �_Approx. Depth I 1 Eastern Surface Seal Installed'UV- <br /> Repair Work Dane ❑ Type of Pump r .14.P. State Work. Done _ <br /> Well Destruction ? ❑ Well Diameter Sealing Material Itop 50') <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW,INSTALLATION l 1 REPAIRIADDITION l I DESTRUCTION i I (No septic system permitted if public sewer is <br /> # . ' ` .. , available within 200 feet.) <br /> Installation will serve: Residence— Commercial— Other j <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ElType/Mfg Capacity ' No. Compartments <br /> PKG, TREATMENT PLT. ❑ Method of Disposal i <br /> Distance to nearest: Well Foundation Property.Line <br /> LEACHING LINE ❑ No. & Length of lines Total length/size �7 <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> i <br /> SEEPAGE PITS I 1 Depth Size Number <br /> SUMPS Ll 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 Di§trict. <br /> Home owner or licensed agent's signature certifies the fallowing: "1 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 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant st call for all required inspections. Complete drawing on reverse side. <br /> Signed X +ri 'r�cF L'4 *�� 13 Title: —_ rJ h.L C Date: <br /> FOR DEPARTMENT USE ONLY i <br /> Application Accepted b _ Date f Area f <br /> Pit or Grout lns otion by Date Final Inspection by ZE Date <br /> Additions! Comments; <br /> ✓ 4. ✓ orf.' 7�Y-(�U►� <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑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 /> /U0 <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED C H RECEIVED ICY V DATE P RMIT'NO. <br /> +.EH1 -24IREV.rin51 � � , � � � �/• �q �S� <br /> EH 144-2a <br />
The URL can be used to link to this page
Your browser does not support the video tag.