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88-2358
EnvironmentalHealth
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PATTERSON PASS
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4200/4300 - Liquid Waste/Water Well Permits
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88-2358
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Last modified
12/6/2019 10:53:44 PM
Creation date
12/1/2017 5:00:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2358
STREET_NUMBER
21945
STREET_NAME
PATTERSON PASS
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
21945 PATTERSON PASS RD
RECEIVED_DATE
09/12/1988
P_LOCATION
SOUZA TEXEIRA DAIRY
Supplemental fields
FilePath
\MIGRATIONS\P\PATTERSON PASS\21945\88-2358.PDF
QuestysFileName
88-2358
QuestysRecordID
1894446
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT ;a r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 7'YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) i i t� <br /> � r�, �t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the w&her escnbed. 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 /> i'om/ / ., <br /> Job Address I i Qqt`l 4 City Lot Size PM i <br /> Owner's Name y ddress 4:i�� Phone <br /> Y� ' Address <br /> Contracto ��& ` C �Lfcense Nv.� a Phone�'� <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION SYSTEM REPAIR �1 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 /> lytdustrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> W—Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> I7 Public Cl Other F Delta Depth of Grout Seal Type of Grout _ <br /> i <br /> I l Irrigation Approx. Depth I I Eastern Surface Seal Installed by * _ <br /> Repair Work Done ❑ Type of Pump H.P. Statef Work Done- " r <br /> Well Destruction ❑ Well Diameter Sealing Material atop 501 <br /> Depth J.. Filler Material {Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAIR/ADDITION i I DESTRUCTION I i (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence Commercial_ Other j <br /> Number of living units: Number of bedrooms <br /> Character of soil to a"depth of 3 feel:" Water table depth. <br /> SEPTIC TANK .El Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ _J Method of Disposal <br /> Distance to nearest: Well" f .. Foundations Property.Line <br /> LEACHING LINE' -❑ No:-&-Length-of lines — -Total length/size' Vt <br /> FILTER BED ❑ Distance ito;nearest:" Well Foundation `.Property Line ° I <br /> SEEPAGE PITS l I Depth ;:I Size — Number <br /> SUMPS Cl Distance to nearest: Well Foundation Property Line f' <br /> DISPOSAL PONDS ❑ . i <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 Dt%ttict. <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 mu required'ingpe ions. Complete drawing on r verse side. <br /> Signed X }r tea`— Title: T Date: <br /> x J <br /> FOR EPARTMENT USE ONLY <br /> i � z <br /> Application Accepted by Data /^ l Area <br /> Pit or Grout Inspection by Date Final Inspection by Date je - <br /> Additional Comments: ` <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621• ❑ 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 /> IFEE <br /> NFO AMOUNT DUI: t AMOUNT REMITTED C K RECEIVED BY DATE PERMIT'NO. <br /> + EH13-24IRE V.tins) <br /> EH 14-28 4 <br />
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