My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
75-60
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
88 (STATE ROUTE 88)
>
17067
>
4200/4300 - Liquid Waste/Water Well Permits
>
75-60
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/20/2024 9:24:19 AM
Creation date
12/4/2017 11:12:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
75-60
STREET_NUMBER
17067
Direction
E
STREET_NAME
STATE ROUTE 88
SITE_LOCATION
17067 E HWY 88
RECEIVED_DATE
3/3/1975
P_LOCATION
DAVID THOMPSON
Supplemental fields
FilePath
\MIGRATIONS\E\88 (HWY 88)\17067\75-60.PDF
QuestysRecordID
1736669
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
t 'dWW� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> FO ICE USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> I // Telephone: (209) 466-6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No-, <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued3 <br /> (Complete 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 Regulations of the San Joaquin Local Health District. <br /> JOB ADDRESS/LOCATION 17067 E. Hiway 88 CENSUS TRACT <br /> Owner's Name David Thompson Phone 267 5122 <br /> Address Rt. 1 Box 35 E City Suter Creek <br /> Contractor's Name W. G. Noack Inc. License #200 794 Phone 466 0696 <br /> TYPE OF WORK (Check) : NEW WELL /? DEEPEN /*7 RECONDITION *-V DESTRUCTION / <br /> PUMP INSTALLATION / / PUMP REPAIR f_1 PUMP REPLACEMENT <br /> Other /_7 <br /> DISTANCE TO NEAREST: SEPTIC TANK ; 60 ft. SEWER LINES PIT PRIVY �1 <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER O <br /> PROPERTY LINE - PRIVATE DOMESTIC WELL PUBLIC DOMESTIC WELL v <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS <br /> Industrial ** Cable Tool Dia.rof Well Excavation 8 inch <br /> ** Domestic/private Drilled Dia. of Well Casing 7 inch <br /> Domestic/public Driven Gauge of Casing 12 gua e Kaiwell <br /> Irrigation Gravel Pack Depth of'. Grout Seal None <br /> Cathodic Protection Rotary Type' of Grout <br /> Disposal Other Other Information <br /> rGeophysical r-- Surface Seal Installed BY: <br /> PUMP INSTALLATION: Contractor San Joaquin P=P- Coe <br /> Type of.Pump Submersible H.P. I <br /> PUMP REPLACEMENT: / / State Work Done <br /> PUMP :REPAIR: ` 1_7 State Work Done - h <br /> ESp —TTRUCTION OF WELL: Well Diameter - �~ - -ly y FApproximate Depth <br /> Describe Material and Procedure <br /> I hereby agree to comply with all laws and regulations of the San Joaquin Local Health District <br /> and the State of California pertaining to or regulating well ,eonstructi.on. Within FIFTEEN DAYS <br /> after completion of my work on a new well, I will furnish the San Joaquin Local Health District a <br /> WELL DRILLERS REPORT of the well and notify them before putting the well in .use. The above <br /> information is true ,to, the best of my knowledge and belief. I WILL CALL FOR A GROUT INSPECTION <br /> PRIOR TO GROUTING AND A FIN INSPECTION. :— <br /> SIGNED .14. Noack Inb. b ' ___. TITLE Salesman <br /> RAW PLOT PLAN ON REVERSE SIDE <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I <br /> APPLICATION ACCEPTED BY DATE .3 -7 <br /> ADDITIONAL COMMENTS: <br /> PHASE II CTI N PHASE III FINAL INSPECTION <br /> Y`�INSPECTION BY DATE 7715r INSPECTION BY DATE - -7d_ — <br /> ' ; 1-74 2M <br /> .it E H :L426 Rev. 1-74 � � � � - <br />
The URL can be used to link to this page
Your browser does not support the video tag.