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88-1426
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4200/4300 - Liquid Waste/Water Well Permits
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88-1426
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Last modified
11/29/2019 10:07:41 PM
Creation date
12/5/2017 1:43:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-1426
STREET_NUMBER
2365
Direction
E
STREET_NAME
EUCLID
City
STOCKTON
SITE_LOCATION
2365 E EUCLID
RECEIVED_DATE
6/6/1988
P_LOCATION
PATRICIA A RUIZ
Supplemental fields
FilePath
\MIGRATIONS\E\EUCLID\2365\88-1426.PDF
QuestysFileName
88-1426
QuestysRecordID
1733894
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone {209) 466-6781 NIS t+t1A <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (6j_"VL/k <br /> �q <br /> (Complete in Triplicate) rti� �' <br /> Application is he+eby made to the San Joaquin Local Health District for a permit to construct and/or install the work hereitAdescribed. his 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 /> J- <br /> Job Address t CityRA Lj Lot Size PM <br /> Owner's NameWAddress Phone <br /> /f �r�/ �} � <br /> Contractor Address License No. Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION 17 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 /> El Industrial D Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> M Public C1 Other F1 Delta Depth of Grout Seal Type of Grout <br /> 1 Irrigation --Approx. Depth I I Eastern Surface Seal Installed by 1V <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done _ <br /> Well Destruction ❑ Well Diameter Sealing Material Itop 501 <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAiR1ADDITION l I DESTRUCTION><INo septic system permitted if public sewer is <br /> available within 200 feet.( �f� <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. 11 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 l I Depth Size Number <br /> SUMPS L1 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 Di3trict. <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 applit n E c II for all required 'ns S. Complete drawing on reverse side. <br /> Signed X Title: �/ sr/ Date: �e <br /> FOR PA ENT USE ONLY // rr22 <br /> Application Accepted by a Date b=�v Area f <br /> Pit or Grout Inspection by Date Final Inspection by t Date a / - IT <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 0 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 /> FEEOUNT DUE AMOUNT REMITTED ASH RECEIVED BY DATE PERMIT NO. <br /> INFO <br /> +. IF -n elv <br /> EH13-241REV.1/96) �,s O� 710 <br /> CH 14-26 � e 1C! <br />
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