My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-3820
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
A
>
ARCHERDALE
>
4731
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-3820
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/20/2019 10:05:19 PM
Creation date
12/5/2017 6:42:16 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-3820
PE
4366
STREET_NUMBER
4731
STREET_NAME
ARCHERDALE
STREET_TYPE
RD
City
LINDEN
SITE_LOCATION
4731 ARCHERDALE RD LINDEN
RECEIVED_DATE
10/16/1987
P_LOCATION
NR DOUG MATTES
Supplemental fields
FilePath
\MIGRATIONS\A\ARCHERDALE\4731\87-3820.PDF
QuestysFileName
87-3820
QuestysRecordID
1644795
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
dtp <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL—ION 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 �/'7 ///1��)��i'd���J A 0) Cit 1l�L.lF i� Lot Size 'PM <br /> Owner's Name�/ �(� �n j� z� Address ( /)Al a/C Phone <br /> ,O i "�` c� <br /> �t�cto� /A) Pumr C' UpP-'/Address 6 Q/ License No.c34-e, Phone2q,7-6394 <br /> TYPE OF WELL/PUMP: NEW WELL 9;-� WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLAT/IO�N� SYSTEM REPAIR ❑ OTHER O <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES /10 ' DISPOSAL FLD. PROP. LINE <br /> FOUNDATION �.�� AGRICULTURE WELL d)f>�LleOTHER WELL Me—PITS/SUMPS D <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> &U-0-mestic/Private ®-Gravel Pack ❑ Tracy Type of CasingSpecifications y� <br /> El Public ❑ Other El Delta Depth of Grout Seal c � Type of GrouteP/v .U/ <br /> ❑ Irrigation � . _Approx. Depth El Eastern Surface Seal Installed by <br /> Repair Work Done IG_Type of Pump 3(113M H.P. J3 State Work Done JIJ <br /> \ <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 <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 CapacityNo. 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 ❑ 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 worj for which this permit is issued,I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant call for all require mspectio s Complete drawi on reverse side. / <br /> Signed v" rtle: , ( Date: IJL/ <br /> FOFJ DEPARTMENT USE ONLY <br /> Application Accepted by Date /� O Area <br /> Pit or Grout Inspection by _ Date Final Inspection by `,1, Date 2- <br /> Additional <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 36.9-3621 ❑ 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 RECEIVED BY DATE <br /> �+PERMIT'NO. <br /> + EH 13-24(REV.t/e 5) ® S�� 713 A, 110-1-147 <br /> EH 14-28 — <br /> i <br />
The URL can be used to link to this page
Your browser does not support the video tag.