My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-3395
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
ELVIN
>
5312
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-3395
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/17/2019 10:15:18 PM
Creation date
12/5/2017 1:07:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-3395
STREET_NUMBER
5312
Direction
E
STREET_NAME
ELVIN
City
STOCKTON
SITE_LOCATION
5312 E ELVIN
RECEIVED_DATE
09/10/1987
P_LOCATION
IRA JACKSON
Supplemental fields
FilePath
\MIGRATIONS\E\ELVIN\5312\87-3395.PDF
QuestysFileName
87-3395
QuestysRecordID
1731589
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.
/
3
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
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. r <br /> Sr Afi,, <br /> Joh Address f� 11�V City Loi Size PM <br /> Owner's Name �� ��]� , .1 ACK250Address E/V1 AJ Phone ' 6 —;,,/] <br /> Contractor Address License No. Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATIO ❑ SYSTE EPAIR ❑- OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTUR ELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLE REA 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 /> ❑ Public ❑ Other ❑ Delta epth of Grout Seal Type of Grout <br /> ❑ irrigation _._ Approx. Depth ❑ East rn Su ce Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION (No septic system permitted if public sewer is <br /> vailable within 200 feet.! <br /> Installation will serve: Residence— Commercial_ Other <br /> 3 <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth (v <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments l <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property Line M <br /> LEACHING LINE ❑ No. & Length of lines Total length/size Cl— <br /> FILTER <br /> FILTER BED ❑ Distance to nearest. Well Foundation Property Line <br /> SEEPAGE PITS ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ r <br /> t 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, 1 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 must call for ail requir inspections. Complete drawing o rev-C/erse side. r <br /> I �Ye)c� lshyt *T"t' <br /> 3nedX <br /> p-g Title: CJS✓1---fid Date: ?—,/to g,;? <br /> I C�T2 � 7jQ FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date �` (7--� Area U <br /> Pit or Grout Inspection by Date Final Iris ction by Date <br /> Additional Comments: <br /> k,.a %A <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 /> INFO AM UYNT DUE AMOUNT REMITTED ASH RECEIVED BY DATE PERmrr'NO. <br /> +EH 13-24(REV.I/H 5) — <br /> EH 14-28 �- / 7�✓ <br />
The URL can be used to link to this page
Your browser does not support the video tag.