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87-1057
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4200/4300 - Liquid Waste/Water Well Permits
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87-1057
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Last modified
9/10/2019 10:17:29 PM
Creation date
12/5/2017 2:32:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-1057
STREET_NUMBER
8563
STREET_NAME
FAIROAKS
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
8563 FAIROAKS RD
RECEIVED_DATE
3/27/1987
P_LOCATION
DELTA DEVELOPMENT CO
Supplemental fields
FilePath
\MIGRATIONS\F\FAIROAKS\8563\87-1057.PDF
QuestysFileName
87-1057
QuestysRecordID
1762803
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PER IT <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) r <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 Ryles and Regulations of the San Joaquin <br /> Local Health District. / <br /> '31 <br /> Job Addressl3xG-. 0040- !tet City-v-c�.c Lot Size PM— <br /> Owner's <br /> ly_Owner's NameAddress Phone <br /> C� <br /> —• Address 1 �+�— License No. <br /> Contractor) ��2 Phone "� S� <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> DIn <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 /> X13 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> ❑ Public Ll Other ❑ Delta Depth of Grout Seal Type of Grout p <br /> 11 Irrigation ---Approx. Depth ❑ Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump .L- H.P. I State Work Done �u <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501) <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ {No septic system permitted if public sewer is <br /> Installation will serve: Residence_ Commercial— Other available within 200 feet.) <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 ❑ 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 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 applic of sq t all for all required inspections. Complete drawing on reverse side. <br /> Signed Title: J Date: <br /> F DEPARTMENT USE ONLY �7 <br /> Application Accepted by 7 Date ��.G7 <br /> Area <br /> Pit or Grout Inspection by Date Final inspection by Date '�� <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 AMOUNT DUE AMOUNT REMITTED CK <br /> CASH T'Nt7# RECEIVED BY DATE PERMi . <br /> + EH 13-24(REV,I/s 5) <br /> EH 1426 <br />
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