My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
79-3
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
D
>
DOS REIS
>
525
>
4200/4300 - Liquid Waste/Water Well Permits
>
79-3
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/22/2019 10:40:13 PM
Creation date
12/4/2017 10:17:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
79-3
STREET_NUMBER
525
Direction
W
STREET_NAME
DOS REIS
STREET_TYPE
RD
City
LATHROP
SITE_LOCATION
525 W DOS REIS RD
RECEIVED_DATE
04/02/1979
P_LOCATION
SEQUNDO MENOR
Supplemental fields
FilePath
\MIGRATIONS\D\DOS REIS\525\79-3.PDF
QuestysFileName
79-3
QuestysRecordID
1716424
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
. SAN JOAQUIN LOCAL HEALTH- DISTRICT <br /> FOR OFFICE USE:, 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209} 46-6791 , <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. <br /> THIS PERMIT EXPIRES l YEAR FROM DATE ISSUED Date Issued <br /> (Complete In In Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. This application is made in compliance with San Joaquin <br /> County Ordinance No. 1862 and the Rules and Regul tions of the San Joaquin Local Health District. <br /> r _ <br /> JOB ADDRESS/LOCATION .GAO CENSUS TRAGI ' <br /> Owner's Name Phone a— 6 r <br /> Address ��� ti(1 <br /> City j <br /> Contractor's Name <br /> .�� License 0�/_1j'_-j_Phone <br /> d <br /> i <br /> TYPE OF WORK (Check) : NEW WELL/ / DEEPEN / / RECONDITION /_/ DESTRUCTION /7 t <br /> PUMP INSTALLATION/ / PUMP REPAIR/ / PUMP REPLACEMENT /7 , <br /> Other <br />`DISfiANGE TO NEAREST: SEPTIC TANK �- SEWER LINES PIT PRIVY <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER <br /> PROPERTY LINE - PRIVATE DOMESTIC WELL PUBLIC DOMESTIC WELL <br /> INTENDED USE TYPE OF WELL CONSTRUCTION. SPECIFICATIONS 3 <br /> Industrial Cable Tool Dia. of Well Excavation <br /> a�Domestic/private Drilled Dia. of Well Casing r <br /> Domestic/public Driven Gauge of Casing *�. <br /> Irrigation Gravel Pack Depth of Grout Seal <br /> Cathodic Protection __ 4rRotary Type of Grout <br /> Disposal Other Other Information - <br /> Geophysical Surface Seal Installed By: --- <br /> PUMP INSTALLATION: Contractor , <br /> Type of Pump H.P. <br /> PUMP REPLACEMENT: . <br /> / / State Work Done <br /> PUMP .REPAIR: State Work Done <br /> DES-TRUCTION OF WELL: Well Diameter - Approximate Depth <br /> Describe Materi'alland Procedure r x* <br /> I hereby agree to 'comply with all laws and regulations o.f-the .San Joaquin Local Health District <br /> and the State"of California pertaining to or regulating well "construction. Within FIFTEEN DAYS <br /> after completion of my work oii-a _neva well, I will furnish the`.San Joaquin Local"-Health-District a <br /> WELL DRILLERS REPORT._of-the.,well .and-.no.tify.them bef.or.e4�put,tirig the�Well-'fn.�use. The above <br /> information_ : is rue to the best of my knowledge and belief. I WILL CALL FOR A GROUT INSPECTION <br /> PRIOR TO G ANkA YAVL INSPECTION. <br /> SIGNED _ TITLE <br /> :ITDRAW PLAN 'ON=RE FRSE SIDE) <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I � y <br /> APPLICATION AC bEPTED BY r DATE <br /> ADDITIONAL COMiENTS: <br /> P, SE II GROUT INSPECTWN -PHASE III/FINAL INSPEC 0 <br /> INSPECTION BY { DATE INSPECTION BY �- DATE <br /> H <br /> 2M <br /> 1426' Rev. 1-7476 <br />
The URL can be used to link to this page
Your browser does not support the video tag.