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89-1298
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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8085
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4200/4300 - Liquid Waste/Water Well Permits
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89-1298
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Last modified
11/20/2024 9:22:32 AM
Creation date
12/4/2017 11:22:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-1298
STREET_NUMBER
8085
Direction
N
STREET_NAME
STATE ROUTE 88
City
STOCKTON
SITE_LOCATION
8085 N HWY 88
RECEIVED_DATE
06/08/1989
P_LOCATION
ALDO NAVONE
Supplemental fields
FilePath
\MIGRATIONS\E\88 (HWY 88)\8085\89-1298.PDF
QuestysFileName
89-1298
QuestysRecordID
1736229
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> `P <br /> * SSAN,JOAQUIN LOCAL-HEALTH DISTRICT <br /> .. <br /> 11.601' , A i ON AVS., STOCKTON 'C� <br /> Telephone (209)1468 6781,5' ; :> G <br /> PERMIT EXPIRES 1'YEAR"F.ROM.DATE ISSUED <br /> Com`(»���1�5' ~, <br /> (Complete in Tiiplicate)' P <br /> ^ q p application is <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and/or install the work herein described. This <br /> made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for welllpump and the Rules and Regulations of the San Joaquin <br /> I Local Health.District, <br /> + City b L abet Size PM <br /> i <br /> Job Address <br /> Phone <br /> y�*.",.•� ' Address `^'� <br /> Owner's Name <br /> License No.3 <br /> Contractor <br /> Address �� =-�"`���� Phone <br /> LACEMENT ❑ DESTRUCTION ❑ <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REP <br /> PUMP INSTALLATION ❑ <br /> SYSTEM REPAIR �1 OTHER 1-1 <br /> SEWER LINES DISPOSAL FLD. PROP. LINE <br /> DISTANCE TO NEAREST: SEPTIC TANK AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> FOUNDATION <br /> l INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS pia. of Well Casing <br /> ❑ Open Bottom ❑ Manteca Dia. of Weil Excavation — <br /> C] Industrial Specifications <br /> T e of Casing <br /> ❑ Domestic/Private ❑ Gravel Pack 0 Tracy Vp Type of Grout <br /> M Public <br /> i� Other ❑ Delta Depth of Grout Seal <br /> I _._Approx. Depth Eastern !a Surface Seal Installed by <br /> irrigation — State Work Done <br /> I fc+ t� H.P. <br /> Repair Work Done -f?� Type of Pump <br /> I <br /> Well Destruction ❑ Well.Diameter I '! <br /> Sealing Material (top 50 J �' <br /> ' Depth Filler Material (Below 501� <br /> TYPE OF SEPTIC WORW. , NEW INSTALLATION l l RFPAIRlADDLT.ION l 1 DESTRUCTION l i alvailablelw thin 200 feetc sys em .) if public sewer is <br /> Installation will serve: Residence— Commercial_ Other ` <br /> Number of living units: Number of bedrooms - -� Water table depth <br /> Character of soil to a depth of 3 feet: No. Compartments <br /> I SEPTIC TANK ❑ Type/Mfg Capacity �— <br /> r Method of Disposal <br /> PKG. TREATMENT PLT. ❑ - t <br /> Distance to nearest: Well 'Foundation Property Line <br /> Total length/size <br /> LEACHING LINE ❑ No. & Length of lines - Property Line <br /> I <br /> FILTER BED EJ Distance to nearest: Weil t �- Foundation <br /> i <br /> SEEPAGE PITS I i Depth <br /> Size umber <br /> Foundation ,iy Property Line <br /> SUMPS L1 Distance to neatest: Well V <br /> d DISPOSAL PONDS ❑ ', ' 4 <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. r ,` � 1 <br /> l 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 /> ! signature <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractto�nhirin ect to workmang or tls c ompensa <br /> r <br /> certifies the following: "I certify that in the performance of the work for which this permit is issued,I shall employ p 1 <br /> tion laws of California.' <br /> The applic t call for all required ctio Complete-drawiµ nig on reverse side. 1 <br /> r Title: <br /> �[/ P Date: <br /> Signed X <br /> 'DEPARTMENT USE ONLY <br /> Dated/ Area <br /> ! Application Accepted by 1 <br /> Date Final Inspection by Date �- <br /> Pit or Grout Inspection by <br /> Additional Comments: <br /> Cl 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.,FP:O. Box 2009, Stk., CA 95201 <br /> 4f <br /> FEEAMOUNT RUE AMOUNT REMITTED CK RECEIVED BY DATE PER NO. <br /> CASH <br /> INFO ` <br /> ♦.EH 13-24(REV.1 3 .00 <br /> EH 14-29 <br />
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