My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-2789
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
A
>
ADELBERT
>
1991
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-2789
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/13/2019 10:36:35 PM
Creation date
3/20/2018 10:31:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-2789
PE
4221
STREET_NUMBER
1991
Direction
S
STREET_NAME
ADELBERT
City
STOCKTON
SITE_LOCATION
1991 S ADELBERT STOCKTON
RECEIVED_DATE
7/23/1987
P_LOCATION
GALE JOHNSON
Supplemental fields
FilePath
\MIGRATIONS\A\ADELBERT\1991\87-2789.PDF
QuestysFileName
87-2789
QuestysRecordID
1632424
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
a�� 1 APPLICATION FOR PERMIT <br /> \ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T 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.sict.'�j ` Q <br /> Job Address / / [ t Jy ' �., City Lot Size PM <br /> Owner's Name Address .Ii;: — Phone <br /> r ` ��y <br /> Contractor� Address License Phon <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOS <br /> FOUNDATION AGRICULTURE WELL HER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM ONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom nteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel P ❑ Tracy Type of Casing Specifications <br /> F1 Public er ❑ Delta Depth of Grout Seal Type of Grout _. <br /> I I Irrigation .Approx. Depth I I Eastern Surface Seal Installed by <br /> Repair W one ❑ Type of Pump H.P. State Work Done_ <br /> Well estruction ❑ Well Diameter Sealing Material (top 50') <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION t-I REPAIR/ADDITION I I DESTRUCTIO (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 k <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg 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 Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS ( I Depth Size _ Number <br /> SUMPS Ll 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 work for which this permit is issued,I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant ust call for all required ins pe tions. Complete drawing on r arse side. ,� ` ^ <br /> Signed Title: 64 ,1 `� Date: <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by �lJ 1� lS� Date Area <br /> Pit or Grout Inspection by Date - Final Inspection by Date <br /> Additional Comments:M2� <br /> ❑ Stk 466-6781 ❑ Lodi -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 -2, <br /> AMOUNT DUE AMOUNT REMITTED CK � � Z3 RECEIVED BY DATE PERMIT'NO. <br /> + EH 13-24 MEV.1/85) O V IS-70 1� l Srdl <br /> EH 14-26 VVV (� <br />
The URL can be used to link to this page
Your browser does not support the video tag.