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86-231
EnvironmentalHealth
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ALPINE
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4200/4300 - Liquid Waste/Water Well Permits
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86-231
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Last modified
9/5/2019 10:11:38 PM
Creation date
12/5/2017 6:04:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
86-231
PE
4366
STREET_NUMBER
4590
STREET_NAME
ALPINE
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
4590 ALPINE RD STOCKTON
RECEIVED_DATE
03/28/1986
P_LOCATION
ARTHUR BACHELOR
Supplemental fields
FilePath
\MIGRATIONS\A\ALPINE\4590\86-231.PDF
QuestysFileName
86-231
QuestysRecordID
1639328
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> _ � r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL 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 /> Local Health District. <br /> Job Address 'Vr%l 41oo�v lye !6 <br /> 1- City Lot Size PM <br /> Owner's Name �oArfes— ���'�Adar� / A_ n.Dt ZT: Phone <br /> Contractor's Name OVOO AA1 I �!' License No. ;:L7 d Z Phone 7Je 35 1 <br /> TYPE OF WELL/PUMP: NEW WELL1n WELL REPLACEMENT DESTRUCTION ❑ <br /> PUMP WS-T*LLAT100� SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. , PROP. LINEA <br /> FOUNDATION AGRICULTURE WELL -Jd_`— OTHER WELL .420 L,'*1TS/SUMPS ACO <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS d <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> Domestic/Private Gravel Pack ❑ Tracy, Type of Casing ��C Specifications A0 <br /> 1-1Public El Other ❑ Delta' Depth of Grout Seal �� Type oT 4ful <br /> ❑ Irrigation ---Approx. Depth ❑ Eastern Surfa a Seal Installed by <br /> Repair Work Done ❑ Type of Pump _ H.P. State Work Done <br /> Well Destruction ❑ Well Diameter _ ~ Sealing Material (top 501 111 <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial_ Other _ <br /> Number of livingunits: Number of bedrooms <br /> Character of soil to a depth pf$^feet:.. Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposai <br /> Distance to nearest: Well Foundation 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 ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> hereby certify that.[ 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 fit 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 diet 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 must call for all required inspec'ons. Complete drawing on reveoe side. <br /> SignedX_�ofTitle: Date: �� !� � <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date v Area + , " <br /> Pit or Grout Inspection by 'Date Final Inspection by Date Y <br /> Additional Comments: 4 r n_4gZN= A-5"- <br /> 0<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 /> FEE AMOUNT DUE AMOUNT REMITTED C SH RECEIVED BY DATE PERMIT"NO. <br /> INFO J in/�hQ] <br /> + EH 1324(REV.10/831 /vsa O W o 1 A Mo 3 R 3 2- <br /> EN W28 I <br />
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