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89-1310
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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89-1310
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Entry Properties
Last modified
12/22/2019 10:04:35 PM
Creation date
12/4/2017 5:08:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-1310
STREET_NUMBER
13864
Direction
S
STREET_NAME
CASTLE
STREET_TYPE
RD
City
MANTECA
SITE_LOCATION
13864 S CASTLE RD
RECEIVED_DATE
4/12/1989
P_LOCATION
W N GOSNELL
Supplemental fields
FilePath
\MIGRATIONS\C\CASTLE\13864\89-1310.PDF
QuestysFileName
89-1310
QuestysRecordID
1683188
QuestysRecordType
12
Tags
EHD - Public
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:F y <br /> 'f APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (' ei-e <br /> pletoo, Corr] fete in Triplicate) <br /> I pms' <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. .II <br /> Job Address/C. ��5 ZL L� � i City Lot Size PM <br /> :I .- <br /> zz <br /> Owner's Name ��� � ,1��0 Address -SC], uL.. Phone <br /> j� <br /> it <br /> Contractor Mlz 11 i7 17 _ Address_pC_ C 1'a ac (cense No. �9?0�+� Phone_ <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION,❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR Aa OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK 1. SEWER LINES DISPOSAL FLD. PROP. LINE <br /> j <br /> FOUNDATION �' AGRICULTURE WFLL 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 /> ii <br /> Domestic/Private 0 Gravel Papck ❑ Tracy Type of Casing 'Specifications <br /> [-]'Public i) Other �P f I Delta Depth of Grout Seal Type of Grout___, [ .. <br /> I <br /> I I Irrigation _Approx. Depth qqI iEastern Surface Seal Installed by _ <br /> Repair Work Done R' Type of Pump H.P. '� State Work Done <br /> oF <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50'I <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIRIADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is <br /> available within 200 feet.) ^ <br /> Installation will serve: Residence! Commercial_ Other l( <br /> Number of living units: Number of bedrooms <br /> ivl <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. ❑ b I ' `�t; Method of Disposal - r <br /> Distance'lo nearest: Well Foundation- -- — ..Property Line <br /> LEACHING LINE Cl No. & Length of lines,°'\` 1 Total length/size <br /> Y ; <br /> 4 <br /> FILTER BED ❑} Distance�pto nearest: Well Foundation � 'Property Line - d� <br /> SEEPAGE PITS I I Depth IM Size _ Number ' <br /> SUMPS Ll Distance�to nearest: 'Well ' t Foundation Property Line y <br /> DISPOSAL PONDS ❑ i[ <br /> I hereby certify that I have prepared this application and that the work will be%done_in'_accordance <br /> _With San..Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin Local Health Dstrict. �"'�x ' <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 su6jedt to workman's compensation laws of California."Contractor's hiring-or sub-contracting signature <br /> certifies the following: "1 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." 1 <br /> The appiica s I! for all required itl <br /> ctions. omelet rowing an revgside. :� <br /> Signed X Title: J /� t`_ _- _-- Date: �-ZZ.-2 <br /> F DEPARTMENT USE ONLY <br /> Application Accepted b, G Date . Area 0 <br /> Pit or Grout Inspection by Date Final Inspection by- J�'JZT� ; Date <br /> .I1I <br /> Additional Comments: <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 /> FEE <br /> INFO AMOUNT DUE II AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. <br /> +.EH 13-24(REV.I/H 5f 3s• <br /> EH 14.28 <br />
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