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88-188
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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88-188
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Last modified
12/2/2019 10:09:50 PM
Creation date
12/5/2017 5:36:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-188
PE
4210
STREET_NUMBER
8460
STREET_NAME
ALICE
STREET_TYPE
AVE
City
THORNTON
SITE_LOCATION
8460 ALICE AVE THORNTON
RECEIVED_DATE
02/02/1988
P_LOCATION
TONY GOMEZ
Supplemental fields
FilePath
\MIGRATIONS\A\ALICE\8460\88-188\1.PDF
QuestysRecordID
1637673
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <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 Rules and Regulations of the San Joaquin <br /> Locale Health District. <br /> Job Address 2 f(® AJA" -�, &,e—• CityALl"� Lot Size PM <br /> Owner's Name d Address A- %A icLtrlPhone <br /> Contract / W Address` ,C• (*-7('77 License No.—':3Q 9,2, 2(o Phon (o -SI O <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION O <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 /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> M Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout _ <br /> I I Irrigation _.Approx. Depth I I Eastern Surface Seal Installed by _ <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done_ <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50') <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION DESTRUCTION I 1 (No''*ptic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence Commercial_ Other <br /> Number of living units: NumberMbedr ms m <br /> Character of soil to a depth of 3 feet: "� Water table depth " <br /> SEPTIC TANK Type/Mfg Capacity QU No. Compartments <br /> PKG. TREATMENT PLT. ❑ LUatd Method of Disposal <br /> Distance to nearest: Well Foundation l® 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 11 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 applicant mut all for all r fired inspections. Complete drawing on re�vsjstde. <br /> Signed X Title: 1/ 1 Date: <br /> 0 �. FOR DEP TMENT USE ONLY <br /> Application Accepted by Date 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 /> v <br /> FEE <br /> INFO �fAMOUNT DUE AMOUNT REMITTED CK�C//A,S/H RECEIVED BY DATE PERRMIT NNO. <br /> + EH 14-24(REV.t/x 5) /1 7 -�� / /J/ �(,11 0/, <br /> EH 14-29 `H tf� U V // <br />
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