My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
75-451
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
F
>
FIG
>
4601
>
4200/4300 - Liquid Waste/Water Well Permits
>
75-451
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
4/25/2019 10:09:30 PM
Creation date
12/5/2017 2:54:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
75-451
STREET_NUMBER
4601
STREET_NAME
FIG
City
MANTECA
SITE_LOCATION
4601 FIG
RECEIVED_DATE
06/12/1975
P_LOCATION
S C NELSON
Supplemental fields
FilePath
\MIGRATIONS\F\FIG\4601\75-451.PDF
QuestysFileName
75-451
QuestysRecordID
1765329
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
SAN JOAQUIN UCAL HEALTH DISTRICT <br /> FOF:OFFICE. USE: b 1.601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209) 466--6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued <br /> (Complete In Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. ' This application is made in compliance with San Joaquin' <br /> County Ordinance No. 1862 and the Rules and Regulations of the San Joa uin Local Health District. ; <br /> JOB ADDRESS LOCATION TAl. /. I. e <br /> ADDRESS/LOCATION eve_ )d2 C' o CENSUS TRACT <br /> r G <br /> Owner s Name 91— Phone ( rjSp(a mox <br /> AddressG'rr!J'J /'IOP a City <br /> Contractor's Name ooh _ License #f�6��g Phone <br /> ��1 <br /> TYPE OF WORK (Check): NEW WELL DEEPEN/ J RECONDITION /_/ DESTRUCTION /? <br /> PUMP INSTLALLATION j f PLUMP REPAIR '/ / PUMP REPLACEMENT /7 <br /> Other <br /> DISTANCE TO NEAREST: SEPTIC TANK pC SEWER LINES lt�o — PIT PRIVY <br /> SEWAGE DISPOSAL FIELD IWI CESSPOOL/SEEPAGE PIT OTHER <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS <br /> Industrial Cable Tool Dia. of Well Excavation / g <br /> Domestic/private Drilled Dia. of Well Casing 51/1 X 12- <br /> Domestic/public <br /> 2Domestic/public Driven Gauge of Casing <br /> Irrigation _ Gravel. Pack Depth of Grout Seal <br /> Other _ Rotary Type of Grout . 0 -e�-/e <br /> Other Other Information ' <br /> PUMP INSTALLATION: Contractor 1 <br /> Type of Pump H.P. . <br /> PUMP REPLACEMENT: f_1 State Work Done <br /> PUMP UPAIR: / / State Work Done <br /> ,DFsTRUCTION OF WELL: Well Diameter Approximate Depth <br /> Describe Material and Procedure <br /> I hereby agree to comply with all laws and regulations of the San Joaquin Local health District <br /> and the State of California pertaining to or regulating well "construction. Within FIFTEEN DAYS <br /> after completion of my work on a new well, I trill -furnish the San Joaquin Local Health District a j <br /> WELL DRILLERS REPORT of .the well and notify them before putting the well in use. The above <br /> information is true to the best of my knowledge and belief. <br /> i SIGNED _ TITLE <br /> (DRAW PLOT PLAN ON REVERSE SID <br /> FOR DEPARTMENT USE ONLY <br /> i PHASE I <br /> APPLICATION ACCEPTED BY DATE .{ — - <br />} ADDITIONAL COMMENTS: T <br /> PUASEti, GROUT INSPECTI N P I/FINAL INSPECTION 1 <br /> INSPECTION BY DATE INSPECTION BY _ DATE <br /> CALL FOR UT INSPECTION PRIOR TO GROUTING AND FINAL INSPECTION. <br /> L I7 Y V <br />
The URL can be used to link to this page
Your browser does not support the video tag.