My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-1567
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
A
>
ANTHONY
>
253
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-1567
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/31/2019 10:26:50 PM
Creation date
12/5/2017 6:31:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-1567
PE
4221
STREET_NUMBER
253
Direction
S
STREET_NAME
ANTHONY
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
253 S ANTHONY AVE STOCKTON
RECEIVED_DATE
04/24/1987
P_LOCATION
JOHN MARTINEZ
Supplemental fields
FilePath
\MIGRATIONS\A\ANTHONY\253\87-1567.PDF
QuestysFileName
87-1567
QuestysRecordID
1643805
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 C <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA 1V kJFL%J1 rU_N%L__k <br /> Telephone (209) 466-6781 �+Q <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED "�""`^`--- �• �--' � <br /> .f (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 /> X53 S �!yi; y 1�_ f <br /> / Job Address !� a O A� City�G-✓40 A.i Lot Size lb 5 X/2 8 PM <br /> X Owner's Name J DN /��/�2 r/�l��r Addresss 3 /9� �n y Phone 3 'SN 7 <br /> Contractor _tea Ir Address License No. 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 /> ❑ Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout <br /> ❑ Irrigation ---Approx. Depth ❑ 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 501 <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION (No septic system permitted if public sewer is w� <br /> available'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 "J <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 1 <br /> SEEPAGE PITS ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that 1 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 \Y <br /> employ any person in such manner as to become subject to workman's compensation IawsKof 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 must call for all required inspections. Complete drawing on reverse side. <br /> Signed X.� Title: A7 y <br /> Date: <br /> (� FOR DEPARTMENT USE ONLY <br /> Application Accepted by w,'\ti-��.,�npti„nr �-�—� Date_ L, y— Ara <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 /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED CASH CK RECEIVED BY DATE PERMI-r NO. <br /> + EH13-24(REV.ii95) <br /> EH 14-28 <br />
The URL can be used to link to this page
Your browser does not support the video tag.