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89-26
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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89-26
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Entry Properties
Last modified
12/31/2019 10:11:05 PM
Creation date
12/5/2017 1:41:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-26
STREET_NUMBER
2216
Direction
E
STREET_NAME
EUCLID
City
STOCKTON
SITE_LOCATION
2216 E EUCLID
RECEIVED_DATE
1/5/1989
P_LOCATION
BOB PAULK
Supplemental fields
FilePath
\MIGRATIONS\E\EUCLID\2216\89-26.PDF
QuestysFileName
89-26
QuestysRecordID
1733720
QuestysRecordType
12
Tags
EHD - Public
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,', S, <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL 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 heiehy 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 �vZ�Cp !9&44",0 -- City Lot Size PM <br /> Owner's Name Rat PA ZIL9 Address S�171E Phone 3� <br /> Contractor r—40 " 4A"A-" Address 7,��D��9�i�?" License No. -0� 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 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 /> I"1 Public D Other Cl Delta Depth of Grout Seal Type of Grout <br /> I 1 Irrigation T_Approx. Depth l I Eastern Surface 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 I ) REPAIR/ADDITION l I DESTR TION (No selltic system permitted if public sewer is <br /> avails a within 200 feet.► <br /> Installation will serve: Residence 1Commercia! 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 /> 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 I I Depth Size Number <br /> SUMPS Cl Distance to nearest: Well Foundation Property Line <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 for all required inspectio Complete drawing on reverse side. r� <br /> Signed X Title: Date: <br /> FOR EPARTMENT USE ONLY <br /> Application Accepted by Date ° Area <br /> Pit or Grout Inspection by Date Final Inspection by4VI Date �C r <br /> Additional Comments: 1 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 /> (FEE OUNT DUE AMOUNT REMITTED GASH RECEIVED BY {TATE PERMIT'No. <br /> r.EH 1324IpEV.r/x5f 5 � � �� � 14� /� <br /> � / <br /> EH 14-26 <br />
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