My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
72-1038
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
B
>
BENEDICT
>
19720
>
4200/4300 - Liquid Waste/Water Well Permits
>
72-1038
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
2/28/2019 10:43:32 PM
Creation date
12/5/2017 9:19:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-1038
STREET_NUMBER
19720
Direction
N
STREET_NAME
BENEDICT
STREET_TYPE
DR
City
WOODBRIDGE
APN
01521060
SITE_LOCATION
19720 N BENEDICT DR
RECEIVED_DATE
9/13/1972
P_LOCATION
WOODBRIDGE SANITARY DISTRICT
Supplemental fields
FilePath
\MIGRATIONS\B\BENEDICT\19720\72-1038.PDF
QuestysFileName
72-1038
QuestysRecordID
1661066
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
SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> FOR OFFICE USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone : (209) 466-6781 <br /> I APPS ATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. �Z_� 63 <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date issued 9-13-7Ti <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 18_62 and the Rules and Regulations of the San Joaquin Local Health District. <br /> JOB ADDRESS/LOCATION /a,C ,;ENSUS TRACT 0(5-ZLO-(�0 <br /> Owner's Name We BODCe ,'� / '' C Phone <br /> Address PA Rd K ,1 ..,_....._., OW 1301-15K_ CXY ZA, City L0121 <br /> Contractor's Name _ �� /?/r W I'rl Z It C License # _1�Phone <br /> TYPE OF WORK (Check): NEW WELL ffr DEEPEN /_/ RECONDITION /_7 DESTRUCTION /_ <br /> PUMP INSTALLATION / / PUMP REPAIR / / PUMP REPLACEMENT /7 <br /> Other 4 IIV l <br /> J N <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY <br /> SEWAGE DISPOSAL FIELD ti CESSPOOL/SEEPAGE PIT OTHER <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 /> Irrigation Gravel Pack Depth of Grout Seal <br /> Other TD _ Rotary Type of Grout <br /> Other 0 <br /> j Cher Information <br /> PUMP INSTALLATION: Contractor <br /> Type of Pump r H.P. <br /> PUMP REPLACEMENT: / / State Work Done <br />' PUMP REPAIR: / / State Work Done <br /> .RESTRUCTION OF WELL: Well Diameter- Approximate Depth <br /> t 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 twhe 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 />` <br /> information is true to the best of my knowledge and belief. <br /> SIGNED TITLE ,( /�,Q (�, �/j7 <br /> (DRAW PLOT PLAN ON REVERSE SIDE <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I r <br /> APPLICATION ACCEPTED BY DATEr--. �— <br /> ADDITIONAL COMMENTS: <br /> PHASE 11 GROUT INSPECTION PHAS III/FINAL INSPECTION <br /> INSPECTION BY DATE INSPECTION BY L(b DATE / 2•//� <br /> CALL FOR A GROUT INSPECTION PRIOR TO GROUTING AND FINAL INSPECTION. <br /> E H.,1426 7/72 1M <br />
The URL can be used to link to this page
Your browser does not support the video tag.