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90-2197
EnvironmentalHealth
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DURHAM FERRY
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4200/4300 - Liquid Waste/Water Well Permits
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90-2197
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Last modified
2/17/2020 1:01:21 AM
Creation date
12/4/2017 10:48:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-2197
STREET_NUMBER
551
Direction
W
STREET_NAME
DURHAM FERRY
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
551 W DURHAM FERRY RD
RECEIVED_DATE
08/07/1990
P_LOCATION
STEVE WILLIAMSON
Supplemental fields
FilePath
\MIGRATIONS\D\DURHAM FERRY\551\90-2197.PDF
QuestysFileName
90-2197
QuestysRecordID
1719357
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> AN J AQUIN LOCAL HE RECEIVED <br /> S O O HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA AUG 17 1990 <br /> Telephone (209) 466-6781 ENVIRONMENTAL HEALTH <br /> PERMIT EXPIRES 1'YEAR FROM DATE ISSUED PERMIT/SERVICES <br /> (Complete in Triplicate) <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 /> Job Addres- /W, �___.� .dn4 � City of Size PM <br /> r+ I � <br /> Owner's Name " W1c dress Phone <br /> f `�� <br /> Contractor Address �`?" L to No.*.52% 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 /> 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 /> Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> F) Public f_l Other Cl Delta Depth of Grout Seal Type of Grout _ <br /> I I Irrigation _.Approx. Depth l I Eastern Surface Seal Installed by <br /> Repair Work Done Y__ Type of Pump H.P. �1-�--�� State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth Fillet Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I 1 DESTRUCTION I I (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: -_ Number of bedrooms <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. ❑ ,Method of Disposal <br /> Distance to nearest: Wel! Foundation Property Line <br /> LEACHING UNE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS I I 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 Diltrict. <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 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 m a for all requited spections. Complete drawing on (ever side. <br /> Signed X--- Title: _-- _ Date: fg---7 <br /> DEPARTMENT USE ONLY <br /> Application Accepted by .FgflDate Area <br /> Pit or Grout Inspection by Date Final Inspection by Date <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 CK I <br /> INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. <br /> + EH 13-24 Ift EV.1/H 5) <br /> EH 14-26 <br />
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