My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-1630
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CARROLL
>
907
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-1630
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/4/2019 10:47:54 PM
Creation date
12/4/2017 4:53:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-1630
STREET_NUMBER
907
Direction
S
STREET_NAME
CARROLL
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
907 S CARROLL AVE
RECEIVED_DATE
4/28/1987
P_LOCATION
CHRISTOPHER P BURGESS
Supplemental fields
FilePath
\MIGRATIONS\C\CARROLL\907\87-1630.PDF
QuestysFileName
87-1630
QuestysRecordID
1681472
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
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)9 <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 well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. <br /> GR/may <br /> Job Address City Lot Size00, <br /> - �- PM <br /> 4 , ...._ <br /> Owner's Name FrfAddress� /q- w // - --- <br /> Phone <br /> MContractor Address License No. Phone <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 /> i FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USETYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> EJ Industrial .❑ Open Bottom ❑ Manteca . Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> a ❑ Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout <br /> ❑ Irrigation --Approx. Depth - ❑ 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 501 <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION (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: t Number of bedr oms Y _f <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. ❑ r Method of Disposal f t <br /> Distance to nearest: Well Foundation Property One <br /> LEACHING LINE ❑ No. & Length of lines Total length/sizer <br /> FILTER BED ❑ Distance to nearest: Well Foundation yProperty Line <br /> r <br /> SEEPAGE PITS ❑ Depth Size T Number <br /> SUMPS ❑ -Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> i <br /> 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 foilo 'ng: "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 alifor <br /> The a icant u I f all requir nspections. Complete drawing on reverse side. �} <br /> Sign 6 Title: Dater <br /> LJ FOR DEPARTMENT USE ONLY i � <br /> Application Accepted by Date ` � Area :03 <br /> 3 /� <br /> Pit or Grout inspection b Date M Final Inspection by Date 77 yl J <br /> Additional Comments: NU ""` 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 955201 <br /> FEE <br /> INFO AM�7OUNT DUE AMOUNT REMITTED CASH CK RECEIVED BY DATE PERMIT'NO. <br /> + EH 13-24(REV.)/ <br /> EH14-28 �J �GalV <br /> " r <br />
The URL can be used to link to this page
Your browser does not support the video tag.