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89-789
EnvironmentalHealth
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88 (STATE ROUTE 88)
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16501
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4200/4300 - Liquid Waste/Water Well Permits
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89-789
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Last modified
11/20/2024 9:22:33 AM
Creation date
12/4/2017 11:10:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-789
STREET_NUMBER
16501
Direction
N
STREET_NAME
STATE ROUTE 88
City
LODI
SITE_LOCATION
16501 N HWY 88
RECEIVED_DATE
4/13/1989
P_LOCATION
ORIN HESTER
Supplemental fields
FilePath
\MIGRATIONS\E\88 (HWY 88)\16501\89-789.PDF
QuestysFileName
89-789
QuestysRecordID
1736294
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephohe 12091 466-6781 <br /> PERMIT EXPIRES TYEAR 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 4 _dz(. City Lot Size74- "'S J PM <br /> Owner's Name ✓, Address Phone <br /> Contractor'fZ E .Uui4146dress 2/202 i2rlJ License No._4322Gi�!__ Phone ,; !- <br /> TYPE OF WELL/PUMP: NEW WELL)R WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION A SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE 342� <br /> FOUNDATION Al 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 12`, Dia. of Well Casing <br /> ,N3 Domestic/Private jN Gravel Pack ❑ Tracy Type of Casing . e,41 /%O Specifications <br /> l"I Public 171 Other Cl 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 ❑ Type of Pump S�21/2 H.P. State Work Done_ <br /> Well Destruction ❑ Well Diameter /�� Sealing Material (top 50') S7*-r'—'A- 9/4As_J] <br /> Depth 24'.5- Filler Material I8elow 50') _- <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION Cl REPAIR/ADDITION 1 I DESTRUCTION I 1 INo septic system permitted if public sewer is <br /> available within 200 feet-1 <br /> Installation will serve: Residence_ Commercial_ Other <br /> Number of living units: Number of bedroorns <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: Well Foundation Property Line <br /> LEACHING LINE 0 No. & Length of lines Total length/size <br /> FILTER BED Cl Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS I I Depth Size Number <br /> SUMPS ❑ 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 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, 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,1 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete drawing on reverse side. <br /> Signed X Title: _�/'/GL/�r Date: CI-13 — <br /> F DEPARTMENT USE ONLY �� <br /> Application Accepted byDV,,,_ Date -C J Area <br /> Pit or Grout Inspection by Date�' Z Final Inspection by Date Z� <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, Silk., CA 95201 <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED By DATE PERMIT'NO. <br /> a EH13-24 IREV.1/H51 a <br /> EH 14-29 <br />
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