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93-707 (2)
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4200/4300 - Liquid Waste/Water Well Permits
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93-707 (2)
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Last modified
6/16/2020 10:09:36 PM
Creation date
12/4/2017 5:26:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
93-707
STREET_NUMBER
2157
STREET_NAME
CHEROKEE
City
STOCKTON
SITE_LOCATION
2157 & 2159 CHEROKEE
RECEIVED_DATE
04/27/1993
P_LOCATION
TONY MACHADO
Supplemental fields
FilePath
\MIGRATIONS\C\CHEROKEE\2157\93-707.PDF
QuestysRecordID
1686514
Tags
EHD - Public
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I' APPLICATION <br /> -� SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH .DIVISION "^ <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P 0 BOB 2009, STOCKTON;,. CA 95201 L. <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 41n <br /> (Complete in Triplicate) <br /> ,,rps lam_% <br /> f <br /> Application is hereby raade•to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with Sen Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. e - <br /> o>1.5 r/7 J Lot Size/Acreage <br /> V'Joh Address � City <br /> � � J <br /> &.-�Owner's Name Address f � -rV- k'�- --- Phone <br /> Contractor �� _Address �� License No. Phone <br /> ervice well 0 <br /> TYPE OF WELL/PUMP: NEW WELL C] WELL REPLACEMENT E7 DESTRUCTION C1 Out Monitoring Well <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE -'i, <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 /> C'.) Domestic/Private ❑ Gravel Pack L1 Tracy tom. Type of Casing_ <br /> Specifications <br /> I'l Public 1-1 Other n Delta Depth of Grout Seal Type of Grout <br /> I I irrigation _Approx. Depth I I Eastern Surface Seal Installed by <br /> Repair Work Done U Type of Pump HIP.✓` _— Sate Work Dana _ <br /> Well Destruction ❑ Well Diameter. r` Sealing lfaterisl,6N.LDepth <br /> Depth ! Filler Material A Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION $Nails otic system <br /> m (eatlted if public sewer <br /> Installation will serve: Residence Commercial flhe� <br /> _Number of living units: Number of bidrooms <br /> Character of soil to a depth of 3 feet: a Water,table depth <br /> SEPTIC TANK ❑ Type/Mfg r Capacit No. Compartments <br /> PKG. TREATMENT PLT. LI, ' Method of Disposal. <br /> Distance to nearest: Well Foundation Property Line <br /> g <br /> Total length <br /> LEACHING LINE 0 No. & Length of e <br /> s <br /> FILTER BED ❑ Distan nearest: Well Foundation Property Line <br /> SEEPAGE PITS l I Depth Size Number t' <br /> SUMPS Ll,, Distance to nearest: Well Foundation Property Line , <br /> AL PONDS ❑ r' <br /> I hereby certify that I have prepared.thi5 application and that the work will be done in.accordance with San Joaquin county ordinances, state laws, and <br /> k rules and regulations of the San Joaquin County <br /> Home owner or licinsed agent's a ignature 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." Con'tractor'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 perions subject tb workman's compensa- <br /> tion laws of California." »t <br /> The applicant•must call for all required inspections./C. mplate drawing on reverse side. — <br /> ' Signed sY "Lit Title: d,O_T~' - Date: <br /> DEPARTMENT USE ONLY kl. S <br /> d A. L <br /> Application Accepted by <br /> Date p res <br /> Pit or Grout Inspection by ate Fi I Inspection by Dats <br /> Additional Comments: <br /> Applicant - Return all copies to: San Joaquin County Public Health Services _fes <br /> Environmental Health Permit/Services �`/y <br /> 445 N San' Joaquin, P O Sox 2009,-,Stkn, CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT•NO. <br /> INFO -2 V <br /> . EH 13.24(REV.I i H e)SD <br /> E �� <br /> E H 11.20 <br />
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