My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
85-1417
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
Y
>
YOUNG
>
2431
>
4200/4300 - Liquid Waste/Water Well Permits
>
85-1417
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/23/2019 10:38:54 AM
Creation date
12/1/2017 3:03:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
85-1417
STREET_NUMBER
2431
STREET_NAME
YOUNG
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
2431 YOUNG ST
RECEIVED_DATE
11/18/85
P_LOCATION
MR HUNT
Supplemental fields
FilePath
\MIGRATIONS\Y\YOUNG\2431\85-1417.PDF
QuestysFileName
85-1417
QuestysRecordID
1997885
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
is ,� •. � ,bf <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE I ON 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 City � Lot Size PM � <br /> Owner's Name Address Phone <br /> r <br /> Contractor dress License No.� Phone �� I <br /> TYPE OF WELL/PUMP NEW ELL ❑ 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 e ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack r ,❑ 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 Cl Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50') <br /> Depth ) Filler Material lBelow 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 /> — <br /> Character of soil to a depth of 3 feet: Water table depth- <br /> SEPTIC TANK ❑ Type/Mfg i 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 tt gth/size <br /> FILTER RED' ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS ❑ Depthr umber <br /> SUMPS 11Distance to nearest: .Well _ Foundation Property Line ° <br /> DISPOSAL PONDS ❑ , <br /> y 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:"l 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 u t call for 1'requir n pections. Complete drawing on rp>e <br /> 4se side. <br /> Signed K Title: Date: <br /> ' FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date Area, <br /> yaU <br /> Pit or Grout Inspection by Date _ Final I pection by D <br /> Additional Comments: v� Y� <br /> Gj�fStk, 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7164 ❑ 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 AMOUNT DUE- AMOUNT REMITTED CK RECEIVED BY DATE PERMIT•NO. <br /> INFO CASH <br /> y'13-24'(REV.siK5) f" v C(,� " rf ► 8'jos 8`s�y�7 <br /> 14ZB <br />
The URL can be used to link to this page
Your browser does not support the video tag.