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73-104
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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8103
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4200/4300 - Liquid Waste/Water Well Permits
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73-104
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Last modified
11/20/2024 9:22:14 AM
Creation date
12/4/2017 11:22:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
73-104
STREET_NUMBER
8103
Direction
N
STREET_NAME
STATE ROUTE 88
City
STOCKTON
SITE_LOCATION
8103 N HWY 88
RECEIVED_DATE
03/02/1973
P_LOCATION
DISALVO RANCH
Supplemental fields
FilePath
\MIGRATIONS\E\88 (HWY 88)\8103\73-104.PDF
QuestysRecordID
1735704
Tags
EHD - Public
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FOR QFFISAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' CE USE: <br /> 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209) 466-6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. <br /> ZLZELLP <br /> THIS PERMIT EXPIRES 1 YEAR FROM. <br /> DATE ISSUED <br /> (Complete In Triplicate) Date Issued _3_,2,7.T <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/L©CATION t'' <br /> - w <br /> Owner's NaCENSUS TRACT <br /> Name t d <br /> Phone :,,EO_pq <br /> Address j 11 <br /> City <br /> Contractor's Name ' <br /> V N C. � License # -�� <br /> Phone <br /> TYPE OF WORK (Check); NEW WELL DEEPEN / / RECONDITION /_7 DESTRUCTION /_' <br /> PUMP INSTALLATION / / PUMP REPAIR / / PUMP REPLACEMENT /? <br /> Other <br /> DISTANCE TO NEAREST: SEPTIC TANK <br /> jjo&l"SEWER <br /> SEWAGE DISPOSALF FIELD O LINE ES /SEEPAGE PIT <br /> OTHER <br /> INTENDED USE TYPE OF WELL <br /> Industrial CONSTRUCTION SPECIFICATIONS <br /> Domestic/private Cable Tool Dia. of Well Excavation <br /> Drilled Dia, of Well Casing <br />_ Domestic/public � <br /> Irrigation Driven Gauge of Casing <br /> Other Gravel Pack Depth of Grout Seal <br />- Rotary Type of Grout <br /> Other Other Information <br /> o <br /> PUMP INSTALLATION: Contractor <br /> r Type of ,Pump <br /> _ <br /> H.P. <br /> PUMP REPLACEMENT:.,,... / / State ,Work Done <br />'UMP REPAIR:, / / State Work Done ` <br />)ESTRUCTION OF'WELL: - .Well„Diame ter <br /> Describe Material and Procedure Approximate Depth <br /> ------------ <br /> hereby agree to comply with all laws and regulations of the San Health District <br /> nd the State of California pertaining to Joaquin Local <br /> or regulating well construction. Within FIFTEEN DAYS <br /> fter completion of.,my work on a new well, I will furnish the San Joaquin Local Health District a <br /> ELL D'RILLERS ',REPORT of - thetwell and notify them before putting the well in use. The above <br /> nformation :is true to the best of my knowledge and belief. <br /> IGNED rl <br /> - - -� _- - �- <br /> TITLE <br /> (DRAW PLOT PLAN ON REVERSE SIDE <br /> 1ASE I DEPARTMENT USE ONLY <br />'PLICATION ACCEPTED <br />)DITIONAL COMMENTS: DATE <br /> PHASE II GROUT. iNSPECTION <br /> fSPECTION BY PRADATEINAL INSPECTIO <br /> INSPECTION BY DATE <br /> CALL FOR A GROUT INSPECTION PRIOR TO GROUTING AND FINAL INSPECTION. <br /> E H 1426 <br /> 7/72 IM <br />
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