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89-1195
EnvironmentalHealth
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ESCALON BELLOTA
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7725
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4200/4300 - Liquid Waste/Water Well Permits
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89-1195
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Last modified
12/22/2019 10:05:38 PM
Creation date
12/5/2017 1:34:37 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-1195
STREET_NUMBER
7725
Direction
N
STREET_NAME
ESCALON BELLOTA
STREET_TYPE
RD
City
LINDEN
SITE_LOCATION
7725 ESCALON BELLOTA RD
RECEIVED_DATE
05/25/1989
P_LOCATION
GEORGE WATKINS
Supplemental fields
FilePath
\MIGRATIONS\E\ESCALON BELLOTA\7725\89-1195.PDF
QuestysFileName
89-1195
QuestysRecordID
1737572
QuestysRecordType
12
Tags
EHD - Public
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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) <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. <br /> Job Address 7725 N. Escalon-Bellota Rd. CitjL nden Lot Size PM <br /> Owner's Name George Watkins Address _7725 N. Escalon-Bs-Ilota Rdhone <br /> ContractorPuryianO Drillers,d s P.O Box 64 Linden License No. 377923 Phone 887-355-4 OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION Jk 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 /> M Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout _. <br /> 1711XIrrigation —.-Approx. Depth 1,7,Eastem Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump sub H.P. 30 State Work Done new pump <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50') <br /> Depth Filler Material {Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION l 1 L.DESTRUCTIONl I (No septic system permitted it public sewer is <br /> t available within 200 feet.) <br /> Installation will serve: Residence_ Commercial . Other ` <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> 9 \ PKG. TREATMENT PLT. ❑ Method of Disposal a <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE ❑ No. & Length of lines 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 /> 1 DISPOSAL PONDS ❑ <br /> Xyl ' 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 /> C\' 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 a scan t call for re ed inspections. Complete drawing on reverse side. <br /> Signed Title: COr Secretary Date: 5/25/89 _ <br /> FOR DEPARTMENT USE ONLY <br /> RApplication Accepted by rm tJ1!--> Date5Area +�1 <br /> Pit or Grout Inspection by Date Final Inspection by. Date <br /> Additional Comments: <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 95201FEE i <br /> INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. <br /> +.EH 14-24 IAEV.r/x 5f �,o //� 9 <br /> 14 <br /> EH 28 <br />
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