My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
79-566
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
F
>
FRISBEE
>
672
>
4200/4300 - Liquid Waste/Water Well Permits
>
79-566
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/25/2019 10:54:43 PM
Creation date
12/5/2017 4:45:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
79-566
STREET_NUMBER
672
Direction
E
STREET_NAME
FRISBEE
City
FRENCH CAMP
SITE_LOCATION
672 E FRISBEE
RECEIVED_DATE
05/24/1979
P_LOCATION
DEL AUCH CONST
Supplemental fields
FilePath
\MIGRATIONS\F\FRISBEE\672\79-566.PDF
QuestysFileName
79-566
QuestysRecordID
1777097
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 LOCAL HEALTH DISTRICT - <br /> FFICE USE: 1601 E. Hazelton Ave. , Stockton, CA 95205 Permit No. Iq -%6 <br /> Telephone: (209) 466=6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Date Issued <br /> (Complete . In -TriplicateY <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 <br /> Joaquin County Ordinance No. 1862 and the Rules and Regulations of the San Joaquin Local Health <br /> District.4 _ <br /> LXACT STREET ADDRESS p/ CITY/TOWNr �eA� i <br /> s Name o� Phnn .� <br /> Address 1.564 e. City 7 { <br /> Contractor's Na License& Phon S'- - c�&rpt <br /> IS CERTIFICATE OF WORKMAN'S COMIPENSATION INSUgAINCE ON FILE WITH SJLHD? YES v� No <br /> TYPE OF WORK (Check) : NEW WELLCO DEEPEN [] RECONDITION DESTRUCTION( <br /> WELL CHLORINATION Q WELL ABANDONMENT p OTHER 0 <br /> PUMP INSTALLATION Nn PUMP REPAIR❑ PUMP REPLACEMENT ( <br /> DISTANCE TO NEAREST: SEPTIC TAN -o/ SEWER LINES' PIT PRIVY <br /> SEWAGE DISP SKAL• FIELDE dF CESOL/SEEPAGE PIT — OTHER <br /> PROPERTY LIN --'PRIVATEDOMESTIC . <br /> --- <br /> N <br /> WELL. PUBLIC DOMESTIC WELL <br /> INTENDED USE TYPE OF WELL j CONSTRUCTION SPECIFICA IONS <br /> Industrial Cable Tool Dia. of Well 'Excavatio / <br /> Domestic/private Drilled Dia. of Well Casing i <br /> Domestic/public Driven Gauge of Casinge4, 55 770 <br /> Irrigation Gravel Pack Depth of Grout Sea <br /> M Cathodic Protection 3t�Rotary Type of Grou e ,v <br /> Disposal Other Other Information <br /> Geophysical A .Surface Seal Instal, ed by <br /> PUMP INSTALLATION: Contracts U 42 S&Ilen <br /> Type of Pump H. <br /> PUMP REPLACEMENT: ❑State Work.Done _ <br /> PUMP REPAIR: . _ Q State Work Done <br /> DESTRUCTION OF WELL: .,Well Diameter Approximate Depth <br /> v Describe Material and Proce ure <br /> I hereby certify that I have prepared this application and that the- work will be done in accordance <br /> with San Joaquin County Ordinances , State Laws, and Rules and Regulations of the San -Joaquin Local <br /> Health District: <br />
The URL can be used to link to this page
Your browser does not support the video tag.