My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
89-2640
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
EDNA
>
1755
>
4200/4300 - Liquid Waste/Water Well Permits
>
89-2640
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/31/2019 10:08:30 PM
Creation date
12/4/2017 11:43:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-2640
STREET_NUMBER
1755
STREET_NAME
EDNA
STREET_TYPE
CT
City
TRACY
SITE_LOCATION
1755 EDNA CT
RECEIVED_DATE
10/25/1989
P_LOCATION
KEN BREINING
Supplemental fields
FilePath
\MIGRATIONS\E\EDNA\1755\89-2640.PDF
QuestysFileName
89-2640
QuestysRecordID
1722680
QuestysRecordType
12
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
s APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA a <br /> Telephone 12091 466-6781 TA. J5 - � P4..�k <br /> PERMIT EXPIRES 1-YEAR FROM DATE ISSUEDn �,\ EAj; . 1C�� <br /> {Complete in Triplicate? E ��1t�C �"\I f�J <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herIlv <br /> e c126,i ed. 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 -3 S w" City nA44dr< Lot Size PM <br /> 17 <br /> Owner's Name �Rja,-, 1.9o — Address 1'674 '` Phone <br /> Conlractor G Address nse No i't� 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 /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia.`of Well Excavation Dia. of Well Casing <br /> Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> 17 Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation ----Approx. Depth l I Eastern t Surface Seal Installed by _ <br /> Repair Work Done ❑ }Type of Pump 4.A - H.P. 16— State Work Done 1 <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50') <br /> Depth Filler Material Melow 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION [ 1 REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is "1 <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial Other <br /> Number of living units: Number of bedrooms b <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 ❑ No. & Length of tines Total length/size <br /> FILTER BED ❑ 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, I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant rpu§t call for ail6r inspections. Complete drawing on averse side. <br /> Signed X !� pfd Title: — Date: <br /> OR DEPARTMENT USE ONLY <br /> Application Accepted by Data/� 7reY" <br /> Pit or Grout Inspection by Date Final Inspection by ate ! <br /> Additional Comments: <br /> ❑ Silk 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 PERMIT NO. <br /> r EH 13-24(REV.i/n5) :?57,d o <br /> EH 14-28 <br />
The URL can be used to link to this page
Your browser does not support the video tag.