My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
88-1272
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
A
>
ANITA
>
3131
>
4200/4300 - Liquid Waste/Water Well Permits
>
88-1272
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/29/2019 10:05:00 PM
Creation date
12/5/2017 6:19:48 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-1272
PE
4221
STREET_NUMBER
3131
Direction
E
STREET_NAME
ANITA
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
3131 E ANITA AVE STOCKTON
RECEIVED_DATE
05/20/1988
P_LOCATION
GARY ANDERSON
Supplemental fields
FilePath
\MIGRATIONS\A\ANITA\3131\88-1272.PDF
QuestysFileName
88-1272
QuestysRecordID
1642430
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
APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 �+ <br /> PERMIT EXPIRES 1YEAR FROM DATE ISSUE <br /> (Complete in Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install he work h rein described. This application is <br /> made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and th ules and Regulations of the San Joaqui <br /> Local Health District. A r <br /> Job Address 3 3 Am L I A ST City ��lCn Lot SizeM Don SJ` PM <br /> Owner's Name 4,4be AD6060 Address 313/ /W 17,-* s?' Phone aYS <br /> Contractor Address G 3c? W C//AY License No. 33`4653 Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <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 /> f'1 Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout — <br /> Vv <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 I I DESTRUCTION (No septic system permitted if public sewer is <br /> avlanable within 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. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <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 I I Depth Size Number <br /> SUMPS Ll 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 fornia." <br /> The app' ant m t call for,al re it inspections. Complete drawing on side. <br /> Signed !/� Title: —XW ;Z Al!1e Date: 51 > <br /> FOR DEPARTMENT USE ONLY <br /> s Z O— <br /> Application Accepted by Date" Area�— <br /> Pit or Grout Inspect' n Date Final Inspection by Date 74 —60 <br /> 0-9 <br /> Additional Comm tol. V 13 — <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑4racy 835-6385 7—I(—� <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201FEE INFO AMOUNT DUE AMOUNT REMITTED A H RECEIVED BY DATE PERMIT'NO. <br /> CASH <br /> EH 13.24 <br /> + EH 14-281REV.1 N5l 00 <br />
The URL can be used to link to this page
Your browser does not support the video tag.