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93-0640
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4200/4300 - Liquid Waste/Water Well Permits
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93-0640
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Last modified
5/19/2020 10:13:33 PM
Creation date
12/1/2017 2:23:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
93-0640
STREET_NUMBER
604
Direction
W
STREET_NAME
WOODBRIDGE
STREET_TYPE
RD
City
WOODBRIDGE
SITE_LOCATION
604 W WOODBRIDGE RD
RECEIVED_DATE
4/19/1993
P_LOCATION
JOHN H BOWLES
Supplemental fields
FilePath
\MIGRATIONS\W\WOODBRIDGE\604\93-0640.PDF
QuestysFileName
93-0640
QuestysRecordID
1992000
QuestysRecordType
12
Tags
EHD - Public
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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 186? and he Rules and Regulations of San <br /> Joaquin County Public Health Services. (..J(�J/0 <br /> Job Address <br /> �QW, � P_ City Lot Size/Acreage <br /> Owner's Name iI _ Address Phone 3 ye- <br /> Contractor 021aY �� Address 4? (�6 A . C�eX F License No&�I �Phone` <br /> TYPE Of WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION Cl Out of Service Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR C1 OTHER ❑ Monitoring Well ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> [Rl Domestic/Private ❑ Gravel Pack El Tracy Type of Casing_ Specifications <br /> I'I Public El Other (l Delta Depth of Grout Seal Type of Grout <br /> I I Irritation _Approx. Dep I I Eastern Surface Seal Installed by ' <br /> Repair Work Done 2 Type of Pump H.P. I State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material b Depth <br /> Depth Filler Material i Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDITION I I DESTRUCTION I i (No septic system permitted if public sewer is <br /> available:wilWn 200 feet.) <br /> Installation will serve: Residence— Commercial Other <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. Companments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> O <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE Cl No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS 11 Depth Size Number <br /> SUMPS LI 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 County <br /> Home owner or licensed agent's signature cenifies 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,-1 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The appfica ust all for all re uired inspections. Completed drawing oonnreverse <br /> �side. <br /> } <br /> Signed X-_ --_ t/Y�itis: / 7= � - Date: <br /> ARTMENT USE ONLY <br /> Application Accepted by Date 1, Area 0 °0' <br /> Pit or Grout Inspection by Date Final Inspection by DateS�3 <br /> Additional Comments: <br /> Applicant - Return all copies to: San Joaquin County Public Health Services <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED CK#_ RECEIVED BY DATE pP1E�RRMI7'NO. <br /> i EH 14-M RIiiKSl �_� �/ ,� �(/ 1 !sJ <br />
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