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88-1805
EnvironmentalHealth
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EIGHT MILE
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4200/4300 - Liquid Waste/Water Well Permits
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88-1805
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Last modified
12/1/2019 10:11:21 PM
Creation date
12/4/2017 11:53:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-1805
STREET_NUMBER
12267
Direction
E
STREET_NAME
EIGHT MILE
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
12267 E EIGHT MILE RD
RECEIVED_DATE
7/20/1988
P_LOCATION
MRS DEVINCENZI
Supplemental fields
FilePath
\MIGRATIONS\E\EIGHT MILE\12267\88-1805.PDF
QuestysFileName
88-1805
QuestysRecordID
1723615
QuestysRecordType
12
Tags
EHD - Public
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ii <br /> 9 <br /> APPLICATION ,FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) 1 <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and/or install the work herein described. This application is i <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. 5. <br /> Job Address ,Md � City Lot Size PM , <br /> � •. Ji <br /> Owner's Name � dress � At— Phone <br /> 3�/S� <br /> w � p <br /> Contractor- J r�% i Address License Nor 3 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 FLO, PROP. LINE <br /> c. <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS { <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 1 <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ DomesticlPrivate ❑ Gravel Pack ❑ Tracy Type;of Casing Specifications <br /> 1`1 Public 11 Other Ca Delta Depth of Grout Seal Type of Grout _. <br /> I I Irrigation _--Approx. Depth I I Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done yV <br /> Well Destruction ❑ Well Diameter Sealing Material Stop 501 <br /> Depth Filler Material (Below 501 t� <br /> ' TYPE OF SEPTIC WORK: NEW INSTALLATION [] REPAIRIADDITION, DESTRUCTION l I (No septic system permitted if public sewer is <br /> available within 200 feet) <br />' Installation will serve: ResidenceCommercial_ Other V <br /> Number of living units: _L_ Number of bedrooms 2 + f <br /> Water table depth d <br /> Character of soil to a depth of 3 feet: p <br /> t <br /> _ .ASEPTIC TANK ❑ Type opacity /��0 No. Compartments09 <br /> PKG. TREATMENT PLT. ❑ Method of Dispeial <br /> e <br /> Distance to nearest: <br /> Well Foundation Property Line <br /> TIN <br /> LEACHING LINE l No. & Length of lines Total length/size r` <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line . ' <br /> SEEPAGE PITS a (__I Dth Size Number <br /> SUMPS t:} L� Distance to nearest: Welt.,_._— Foundation Property Line <br /> f DISPOSAL PONDS f ❑ <br /> i I hereby certify that I have prepared this application and that the work will tae done in accordance with San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin Local Health DiMrict. 1i <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 followin : "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 Califor i P !b <br /> The applica t all for equire i tt5n m a drawing on r, rse side. <br /> Signed X Title: Date: r�y <br /> ^ R DEPARTMENT USE ONLY 1 <br /> Appli ion Accepted byeet - �„ Date v 4 Area <br /> Date Final Inspection by � �G � � ""Dates <br /> �i rout tion by —; <br /> Additional Comments: " <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 Cl 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 /> I! <br /> FEET DUE AMOUNT REMITTED CK RECEIVED BY ATE PERMIT'NO. <br /> INFO CG <br /> ASH p� L7? o y <br /> +.EH IRE'V.I/A51 � /^�()��O � , <br /> 7 <br /> 13-24 d Ur <br /> EH 14-26 <br /> i, TIM <br />
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