My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
84-1066
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
W
>
WOLFE
>
8087
>
4200/4300 - Liquid Waste/Water Well Permits
>
84-1066
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/10/2019 5:34:30 PM
Creation date
12/1/2017 2:04:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
84-1066
STREET_NUMBER
8087
STREET_NAME
WOLFE
STREET_TYPE
RD
City
FRENCH CAMP
SITE_LOCATION
8087 WOLFE RD
RECEIVED_DATE
08/21/1984
P_LOCATION
JOHN VAN DYKE
Supplemental fields
FilePath
\MIGRATIONS\W\WOLFE\8087\84-1066.PDF
QuestysFileName
84-1066
QuestysRecordID
1990296
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
r <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 AUG 2 01984 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) SAN JOAQUIN LOCAL <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construHEALTH DISTRICT <br /> ct 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. ff6���d <br /> L—C/'� ' <br /> Job Address City,A Size <br /> PM <br /> Owner's Name L>'n V Address ( ��r _ ke <br /> Contractor's Name License No. Gok Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 5'R <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 09❑ Public El Other ❑ Delta Depth of Grout Seal Type of Grout o <br /> ❑ Irrigation ---Approx. DeRth ❑ Eastern surface Seal Installed by 0Q <br /> Repair Work Done ❑ Type of Pump H.P. tate Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50'} VP <br /> Depth Filler Material (Below 50'} # <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ . REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial— Other a <br /> Number of living units: Number of bedrooms i4 <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg CapacityNo. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <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 ❑ Depth Size Number ¢ <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line i. <br /> DISPOSAL PONDS ❑ <br /> 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 must call f required inspections. Complete drawing on re erse side. (� <br /> Signed – Title: C�-�-� Date: e7 <br /> FOR DEPARTMENT USE ONLY Q <br /> Application Accepted by Date v ~ Area k <br /> �G s <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> ,Additional Comments: <br /> tk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-631 <br /> Apple nt- Return all copies to: Environmental Heafth Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE AMOUNT DUE AMOUNTRE K RECEIVED BY DATE PERMIT"NO. F <br /> INFOCASR <br /> +EH 13-24 IREV.10183) <br /> EH 1428 1 <br /> i <br />
The URL can be used to link to this page
Your browser does not support the video tag.