My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
89-2436
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
F
>
F
>
2121
>
4200/4300 - Liquid Waste/Water Well Permits
>
89-2436
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/30/2019 10:11:11 PM
Creation date
12/5/2017 2:09:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-2436
STREET_NUMBER
2121
Direction
N
STREET_NAME
F
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
2121 N F ST
RECEIVED_DATE
10/02/1989
P_LOCATION
FLORENCE SHIPPMAN
Supplemental fields
FilePath
\MIGRATIONS\F\F\2121\89-2436.PDF
QuestysFileName
89-2436
QuestysRecordID
1760778
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. 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. ��-/�-//��"" yy ^ ]� <br /> Job Address _ _ City t Lot Sizer! �.!�' PM <br /> Owner's NamerOr�'1« 1 ,�j .. Addressin�t�V 0� 6-�O��LLLR. PhoneZLI <br /> " <br /> Contractor I Ira Address C� X546 <br /> 7 <br /> License No. ! 0 Phane <br /> TYPE OF WELL/PUMP; WW WELL El 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 LJ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> 1-1 Public Cl Other CJ Delta Depth of Grout Seal Type of Grout <br /> i I Irrigation --Approx. Depth (.I Eastern Surface Seal Installed by r <br /> Repair Work Done ❑ Type of Pump H,P. State Work Done <br /> Well Destruction Cl Well Diameter Sealing Material (top 501 <br /> Depth Filler Material (Below 50') <br /> YPE OF SEPTIC WORK: NEW INSTALLATION f 1 REPAIRIADDITION (.I DESTRUCTION (No septic system permitted it public sewer is <br /> available within 200 feet.) 1 <br /> Installation will serve: Residence— Commercial_ Other <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth o1 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal - C <br /> Distance to nearest: Well Foundation Property Line f, " <br /> LEACHING LINE ❑ No. & Length of lines Total length/size f <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> w n <br /> SEEPAGE PITS i I 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, and <br /> rules and regulations of the San Joaquin Local Health DrItrict. <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 /> t <br /> The applicant must call f r all required in c ons. Complete drawing on reverse side. s F <br /> .. r <br /> Signed X Title: sUlIrQ' -+ <br /> d Date: -fQ � ► <br /> _ FORDEPARTMENT USE ONLY <br /> Application Accepted by T�,�-,? <br /> Date Q" � Area ' <br /> Pit or Grout Inspection by Date Final Inspection by Dat <br /> Additional Comments: 6 <br /> -- ❑ Stk.-466-&781 O Lodi" 369-36211 .— - ❑ Mantic—a,1-823-7104—m❑ Tracy 835-6385 <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Sik., CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED <br /> INFO RECEIVED BY DATE PERM17'NO. <br /> ♦.EH 13-24{REV.r/H 5y <br /> EH 14-28 SZ <br /> 243b <br /> I <br />
The URL can be used to link to this page
Your browser does not support the video tag.