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90-553
EnvironmentalHealth
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88 (STATE ROUTE 88)
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24968
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4200/4300 - Liquid Waste/Water Well Permits
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90-553
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Last modified
11/20/2024 9:22:35 AM
Creation date
12/4/2017 11:18:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-553
STREET_NUMBER
24862
Direction
N
STREET_NAME
STATE ROUTE 88
City
CLEMENTS
SITE_LOCATION
24862 N HWY 88
RECEIVED_DATE
03/14/1990
P_LOCATION
GREGG LEWIS
Supplemental fields
FilePath
\MIGRATIONS\E\88 (HWY 88)\24968\90-553.PDF
QuestysFileName
90-553
QuestysRecordID
1735546
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT _ <br /> ` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE.T ON 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 <br /> _�2 q29 �� City `"" Lot Size PM <br /> 72T44, <br /> F �[ <br /> I 'td Q 2 Phone 3 1"! <br /> k Owner's Name .• Address _ <br /> F Contractor gd�&.- dress Aw Ir2 No. r 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 /> 4 <br /> ❑ Industrial ❑� Open Bottom El Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ElLK <br /> Domestic/Private Gravel Pack ❑ Tracy p Type of Casing $ `68 Specifications <br /> FI Public 171 Other ❑ Delta Nk �, M'Depth of Grout Seal Type of Grout . <br /> Ia�Iian __Approx. Dep I Eastern Surface Seal Installed by _ <br /> I Repair Work Done ❑ Type of Pump 444A, H.P. ;e d State Work Done <br /> Well Destruction ❑ Well Diameter tr Sealing Material Itop 50'1 vCC` <br /> Depth _x/117 Filler Material (Below 501 —_ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAIR/ADDITION I I DESTRUCTION I I (No septic'system permitted if public sewer is S <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 /> i PKG. TREATMENT PLT. ❑ Method of Disposal `F <br /> Distance to nearest: Well Foundation Property Line <br /> 0 <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> i SEEPAGE PITS I I Depth Size _ Number CK <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line G� <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 Di%trict. 1�_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: 1 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 ust call for all requir inspections. Complete drawing on reverse side. <br /> Signed X Title- _ .OM.��c./ Date: <br /> ' 0 <br /> PARTMENT USE ONLY <br /> Application Accepted by 44 DateArea <br /> Pit or ro Inspection by�a�� Date�? y��l5 Final Inspection by / DateZ.� <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 INFO AMOUNT DUE AMOUNT� REMITTED CASH RECEIVED BY DATE /� P;EIRMI7'NO. <br /> + EH 13-24 EH 14-2erREV.1/N 5) `I!S+�� �.aJ Vqf�; /M �DJ <br /> h 0 `� <br />
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