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89-1225
EnvironmentalHealth
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DURHAM FERRY
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4200/4300 - Liquid Waste/Water Well Permits
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89-1225
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Last modified
12/22/2019 10:06:44 PM
Creation date
12/4/2017 10:51:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-1225
STREET_NUMBER
6685
Direction
W
STREET_NAME
DURHAM FERRY
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
6685 W DURHAM FERRY RD
RECEIVED_DATE
05/22/1989
P_LOCATION
ED SASAKI
Supplemental fields
FilePath
\MIGRATIONS\D\DURHAM FERRY\6685\89-1225.PDF
QuestysFileName
89-1225
QuestysRecordID
1719596
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZETON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <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 Address 2itJ /V City "L" Lot Size PM <br /> Owner's Name - L3t-c{ rte+ Address ? �--' <br /> Phone <br /> Contractor ' <br /> ddress ; r2 ' �' License No. - 3916 - Phone '' � 1 <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION,k, 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 /> El Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> `Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications t� <br /> i'I Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout---,- <br /> I <br /> rout_ __I I Irrigation — Approx. Depth l I Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump��_Z_ H.P. State Work Don Qeaa/� z %fes fry) <br /> —..—T— <br /> Well Destruction ❑ Well Diameter Sealing Material (top 5011 <br /> Depth Filler Material i8elow 50'1 _ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION l 1 REPAIR/ADDITION l I DESTRUCTION I 1 INo 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: ' <br /> Water table`depth� ���' ��� I+�I�. <br /> SEPTIC TANK ❑ Type/Mfg is ' <br /> Capacity No. Compartrrsents 4° ? <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property Line n�, 0 1 9 6 9 <br /> LEACHING LINE ❑ No. & Length of lines Total length/size M i U <br /> FILTER BED ❑ Distance to nearest: Well FoundationProperty Line 1', /i � 'v ti�AL Ht A,l <br /> !::1 E1=i ir�r <br /> SEEPAGE PITS I I Depth Size _ Number <br /> SUMPS Ll Distance to neatest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> 1 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, 1 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 appliz5zl= <br /> spections. Complete drawing on reverse side. <br /> Signed X Title: >-�— <br /> Date4 <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date Area <br /> I <br /> Pit or Grout Inspection by Data Final Inspection by. Data 3,257 <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 AMOUNT DUE AMOUNT REMITTED CK <br /> INFO CAS FI RECEIVED 6Y DATE PERMIT NO. <br /> + EH1 -24fREV.t/H5f ' `3' <br /> EH 144-28 � / <br />
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