My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
76-825
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
A
>
ARCH
>
0
>
4200/4300 - Liquid Waste/Water Well Permits
>
76-825
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/12/2019 10:09:34 PM
Creation date
12/5/2017 6:37:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
76-825
PE
4382
STREET_NAME
ARCH
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
ARCH RD STOCKTON 1/2 MILE WEST AUSTIN
RECEIVED_DATE
09/03/1976
P_LOCATION
FRANK RAY
Supplemental fields
FilePath
\MIGRATIONS\A\ARCH\0\76-825.PDF
QuestysFileName
76-825 (2)
QuestysRecordID
1644531
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
Qin ��.fa r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> FOE OFFIC USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209) 466-6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued 7-7� <br /> (Complete In Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. This application is made in compliance with San Joaquin <br /> County Ordinance No. 1862 and the Rules and Regulations of the San Joaquin Local Health District. <br /> JOB ADDRESS/LOCATIONate etip Alas,14 Audl&'Rwon or J � CENSUS TRACT <br /> Owner's Name Phone <br /> - ,--� <br /> a �7Address •f'--E,,;rn /s 4 �`y" ! d G City S T&",— <br /> Contractor's Name SAr as 0,6/ -, GtJ License # /137-1,j Phone (4 } - 7C.,;7C <br /> TYPE OF WORK (Check) : NEW WELL/ / DEEPEN / / RECONDITION /_7 DESTRUCTION /7 <br /> PUMP INSTALLATION/ / PUMP REPAIR KI PUMP REPLACEMENT /_ <br /> Other / / <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER <br /> PROPERTY LINE - PRIVATE DOMESTIC WELL PUBLIC DOMESTIC WELL <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS <br /> Industrial Cable Tool Dia. of Well Excavation <br /> Domestic/private Drilled Dia. of Well Casing <br /> Domestic/public Driven Gauge of Casing <br /> c� Irrigation Gravel Pack Depth of Grout Seal <br /> Cathodic Protection Rotary Type of Grout <br /> Disposal Other Other Information <br /> Geophysical Surface Seal Installed By: <br /> PUMP INSTALLATION: Contractor 4� <br /> Type of Pump =A e el& H.P. d <br /> PUMP REPLACEMENT: / / State Work 'Done <br /> PUMP .REPAIR: State Work Done Are <br /> DESTRUCTION OF WELL: Well Diameter Approximate Depth <br /> Describe Material and Procedure <br /> I hereby agree to comply with all laws and regulations of the San Joaquin Local Health District <br /> and the State of California pertaining to or regulating well'construction. Within „FIFTEEN DAYS <br /> after completion of my work on a new well, I will furnish the San Joaquin Local Health District a <br /> WELL DRILLERS REPORT of the well and notify them before putting the .well in use. The above <br /> information ;is true to the best ofno ledge. nd belief. I WILL CALL FOR A GROUT INSPECTION <br /> PRIOR TO GRO TING .AND A FINAL INS?.E IO <br /> SIGNED ITLE ,r ,,f <br /> D <br /> PMT-PLAN ON RWERSE SIDE) <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I <br /> APPLICATION ACCEPTED BY F M DATE /57 3 -7Z <br /> ADDITIONAL COMMENTS: -- <br /> PHASE II OUT INSPECTION PHASE III INAL INSPECTION <br /> INSPECTION BY /1/ DATE INSPECTION BY _ DATE <br /> 3/76 2M <br /> E H 1426 Rev. 1-74 <br />
The URL can be used to link to this page
Your browser does not support the video tag.