My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
72-33
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
F
>
FRENCH CAMP
>
5269
>
4200/4300 - Liquid Waste/Water Well Permits
>
72-33
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/20/2019 10:04:03 PM
Creation date
12/5/2017 4:31:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-33
STREET_NUMBER
5269
Direction
E
STREET_NAME
FRENCH CAMP
STREET_TYPE
RD
APN
20104006
SITE_LOCATION
5269 E FRENCH CAMP RD
RECEIVED_DATE
2/10/1972
P_LOCATION
B & B FARMS/A BROCCHINI
Supplemental fields
FilePath
\MIGRATIONS\F\FRENCH CAMP\5269\72-33.PDF
QuestysFileName
72-33
QuestysRecordID
1774829
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
FOR OFFICE USE: APPLICATION FOR WELL OR PUMP PERMIT PERMIT NO.Y •7Z-3 5 <br /> (Complete in Triplicate) Date Issued: z <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN LOCAL HEALTH DISTRICT FOR A PERMIT TO PERFORM <br /> THE WORK STATED HEREON. THIS APPLICATION IS MADE IN COMPLIANCE WITH COUNTY ORDINANCE <br /> NO. 1862 AND RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT, <br /> 5-aC1111 1E.1..ice• 44 le A-Ir0�d t 0,C-0—,0G <br /> JOB ADDRESS/LOCATION: �t d,41,5,4 ti F�e.,,ca j f- o s�- CENSUS TRACT: <br /> OWNER'S NAME: cr_I,, . w PHONE: <br /> ADDRESS: CITY: <br /> CONTRACTORS NAME: I 3`]� PHONE: .4 _ (o <br /> INTENDED USE: INDIVIDUAL DOMESTIC WATER WELL /% PUBLIC WATER WELL / / TEST WELL /_7 <br /> IRRIGATION/LV�_RS.TOCW RWTU �L WATER WELL g/� INDUSTRIAL WATER WL / <br /> CATHODIC PROTECTION WELL-•/ / GEOPHYSICAL WELL /% EL <br /> OTHER <br /> NEW WELL: DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY <br /> SEWAGE DISPOSAL FIELD CESSPOOL SEEPAGE PIT OTHER <br /> REPAID°,. £TYPE .0 REPAIRS: � + <br /> n <br /> ABANDONMENT/DESTRUCTION: METHOD TO E USED* <br /> i <br /> PLOT PLAN: SHOW ON REVERSE SIDE <br /> I HEREBYERTIFY THAT HAVE P EPARED IS APPLICATION AND THAT THE WORK WILL BE DONE IN <br /> ACCORDANCE WITH THE PR VISI O S 0 LAWS OF THE STATE OF CALIFORNIA, THE ORDINANCES OF THE <br /> COUNTY OF SAN JOA UIN T E $ REGULATIONS OF THE SAN JOAQUI OCAL TH D STRICT. <br /> 10 <br /> SIGNED: CONTRACTOR: <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I <br /> APPLICATION ACCEPTED BY: DATE: <br /> ADDITIONAL COMMENTS: <br /> PHASE II PHASE IIT FINAL <br /> INSPECTION BY: DATE _ _ INSPECTION BY: DATE <br /> E H 1426 SAN JOAQUIN LOCAL_ HEALTH_DISTRICT 3/72 1M <br /> DISTRIBUTION: WHITE-HEALTH DISTRICT -- YELLOW-PROPERTY OWNER - PINK-CONTRACTOR <br />
The URL can be used to link to this page
Your browser does not support the video tag.