My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
89-2254
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
W
>
WOLFE
>
9251
>
4200/4300 - Liquid Waste/Water Well Permits
>
89-2254
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/28/2019 10:05:40 PM
Creation date
12/1/2017 2:06:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-2254
STREET_NUMBER
9251
Direction
S
STREET_NAME
WOLFE
STREET_TYPE
RD
City
FRENCH CAMP
SITE_LOCATION
9251 S WOLFE RD
RECEIVED_DATE
09/12/1989
P_LOCATION
RAY MULLER
Supplemental fields
FilePath
\MIGRATIONS\W\WOLFE\9251\89-2254.PDF
QuestysFileName
89-2254
QuestysRecordID
1990154
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 /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone {2091 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> i <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 welUpump and the Rules and Regulations of the San Joaquin <br /> Local Health District. <br /> Job Address /O � L Q /y City Lot Size �^� PM <br /> Owner's Name / (/ I�LL-die Address Phone '1 <br /> ContractorAddress 1W License No Phone L <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL KEPLACEMENT ❑ 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 F1 Other ❑ Delta Depth of Grout Seal Type of Grout _ <br /> irrigation _.Approx. Depth I I Eastern Surface Seal Installed by _ <br /> Repair Work Done ❑ Type of PumpH.P. 3 State Work Done !l <br /> Well Destruction -, ❑ Well Diameter � Sealing Material (top 501 <br /> Depth `` ,.5 Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION l 1 DESTRUCTION I 1 (No septic system permitted if public sewer is <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 1 Depth Size Number <br /> SUMPS ❑ 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,__4e <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."Contractors 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 st call for uired mspeotions. Complete drawing on reverse side. <br /> Sign d X Title:L� l ��C Date: <br /> FOkDEPARTMENT USE ONLY <br /> Application AcceptZby Date Z ` Area ,^�/�/rte <br /> Pit or Grout Inspection by Date Final Inspection b Dat r <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 95201 <br /> FEE <br /> INFO AMOW DUE AMOUNT REMITTED A GASH RECEIVED BY DATE PERMIT'NO. <br /> ♦ EH 1 -24(REV.t/M 51 �� � r Y6 /1 <br /> EH 144-26 111.✓✓,����(ll../// ' ^vSpC J <br />
The URL can be used to link to this page
Your browser does not support the video tag.