My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
88-288
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
EUCLID
>
2328
>
4200/4300 - Liquid Waste/Water Well Permits
>
88-288
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/9/2019 10:34:31 PM
Creation date
12/5/2017 1:42:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-288
STREET_NUMBER
2328
Direction
E
STREET_NAME
EUCLID
City
STOCKTON
SITE_LOCATION
2328 E EUCLID
RECEIVED_DATE
2/16/1988
P_LOCATION
MARIE SANCHEZ
Supplemental fields
FilePath
\MIGRATIONS\E\EUCLID\2328\88-288.PDF
QuestysFileName
88-288
QuestysRecordID
1733834
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
APPLICATION FOR PERMIT �. <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICTS--l' <br /> 3601 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. ry / `' y <br /> Job Address � �� �r City 57-oe -r_M.t Size V a� /1 /GU PM <br /> t <br /> Owner's Named (iCJ� dress � Phone <br /> Contractor Address License No. Phone <br /> TYPE OF WELL/P P: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTI TA SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM A CON CTION SPECIFICATIONS <br /> ❑ Industrial C Open Bottom ❑ Manteca of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Type asing Specifications <br /> F] Public ❑ Other Cl Delta Depth of Gr t Seal Type of Grout <br /> I I Irrigation _.-Approx. Depth I I Eastern Surface Seal Ins ad 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 I 1 DESTRUCTION (No septic system permitted if public sewer is t <br /> 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 /> 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 Depth Size Number <br /> SUMPS D Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <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 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 compansa- <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete drawing on reverse side. J {� <br /> Signed X- /I lfrp- �,{ Title: -_ Date- <br /> FOR <br /> v <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date I J o`�f / Area <br /> Pit or Grout Inspection by Date Final ns ction byy d�„C� Date <br /> Additional Comments: S 5 <br /> ❑ Stk 46fi-6781 ❑ Lodi 369-3&21 ❑ Manteca 823 7104 ❑ T cy 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 INFO AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY (DATE PERMIT-NO. <br /> r.EH 13-24{REV.I/n 51 Or <br /> ( .. " <br /> EH 14-28 <br />
The URL can be used to link to this page
Your browser does not support the video tag.