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90-2958
EnvironmentalHealth
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EMERSON
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3949
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4200/4300 - Liquid Waste/Water Well Permits
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90-2958
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Entry Properties
Last modified
3/2/2020 2:04:33 AM
Creation date
12/5/2017 1:11:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-2958
STREET_NUMBER
3949
Direction
E
STREET_NAME
EMERSON
STREET_TYPE
RD
City
ACAMPO
SITE_LOCATION
3949 E EMERSON RD
RECEIVED_DATE
11/08/1990
P_LOCATION
KENNETH FERRERO
Supplemental fields
FilePath
\MIGRATIONS\E\EMERSON\3949\90-2958.PDF
QuestysFileName
90-2958
QuestysRecordID
1732163
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY -PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. HAZELTON AVE. , PHONE (209)46$-3420 <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> -PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application is hereby made.to San'Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public [Hee�altthh,I Services. <br /> Joh Address �J�Z2.Qi7r A � City Lot Si ze/Acreage a <br /> Owner's Name Phone -3-3z"� <br /> r � <br /> ContractorfMZYL. Address icense No Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT M V DESTRUCTION ❑ Out of Service Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑.. OTHER ❑ Monitoring Well <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 /> F1 Industrial ❑ Open Bottom ❑ Manteca Dia.•.of.-Well-Excavation- Dia. of Well Casing `. <br /> [J Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> l'I Public 0 Other n Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation ._.._.Approx. Depth I 1 Eastern Surface Seal Installed-by <br /> Repair Work Done 0 Type of Pump H.P. State Work Done _ <br /> Well Destruction ❑ Well Diameter Sealing'Naterial & Depth <br /> Depth Filler Material & Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I IREPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is <br /> 1 ��.���.,available-within 200 feet.) <br /> Installation will serve: Residence 1 Commercial_ ther . i <br /> Number of living units: _ Number of bedrooms <br /> Character of soil to a depth of 3 feet: ° Water table depth <br /> SEPTIC TANK D Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ ,r• Method of Disposal <br /> Distance to nearest: t Well �QFoundation 0 Property Line <br /> M <br /> ,i G <br /> LEACHING LINE ❑ No. & Length of lines -� Tota! length/size ` <br /> FILTER BED CJ Distance to nearest: Well Foundation 7,d Property Line ~ , <br /> SEEPAGE PITS 11 Depth Size r r� `M� <br /> Number <br /> SUMPS LI Distance to nearest: Well -- Foundation Property Line <br /> DISPOSAL PONDS p j <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 County <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 /> i certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> 4 tion laws of California." , <br /> The applicant t c r requir d 7' s �Compawing on reverse side. i <br /> Signed <br /> Title: Date: <br /> R DEPARTMENT USE ONLY <br /> Application Accepted by Date 87 ID Area <br /> Pit r Grout Inspection by Date I Final Inspection by _ Daie� (43— <br /> r I F <br /> Additional Comments: &Je,014 <br /> APplice.at - Return all copies to: San Joaquin County Public Health <br /> Services, Environmental Health Permit/Services <br /> 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 ' <br /> EEE <br /> NFO AMOUNT DUE AMOUNT REMITTED CK RECEIVER BY <br /> ICASH DATE PERMIT NO. <br /> q <br /> . Er, 13.21(REV., s, <br /> EH 1I.20 l <br />
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