My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
86-504
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
P
>
PINE
>
8927
>
4200/4300 - Liquid Waste/Water Well Permits
>
86-504
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/7/2019 10:16:34 PM
Creation date
12/1/2017 5:49:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
86-504
STREET_NUMBER
8927
STREET_NAME
PINE
STREET_TYPE
ST
City
THORNTON
SITE_LOCATION
8927 PINE ST
RECEIVED_DATE
5/8/1986
P_LOCATION
PAULINA EVANGELISTA
Supplemental fields
FilePath
\MIGRATIONS\P\PINE\8927\86-504.PDF
QuestysFileName
86-504
QuestysRecordID
1899740
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
R APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (2091 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. !� 7 f <br /> Job Address � ` ' N� City -' a <br /> of Size PM <br /> Owner's Name tJ /W& CLQ e '¢ a7 /Mer Phone <br /> Contractor 1 E'•tn�t-++t�Address__ a a/Q b _License No.��A kJ Phone —01'rot <br /> TYPE OF WELL/PUMP: NEW WELL ❑ 3 S:WELL R€PLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYS_�E(M REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ <br /> i <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> ❑ Public ❑ Other ❑ Delta 3� Depth of Grout Seal Type of Grout <br /> ❑ Irrigation —Approx. Depth ❑ Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50')" 00 <br /> Depth Filler Material (Below 56 <br /> 1 V, <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION E74.REPAIR/ADDITION DESTRUCTION ❑ (No septic system permitted if public sewer is N <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 "'t, ! <br /> SEPTIC TANK ❑ Type/Mfg Capacity o No. Compartments Z, t. <br /> PKG. TREATMENT PLT. ❑ r r . . a Method of Disposal ` f <br /> Distance to nearest: Well FoundationC�.. Property Line <br /> LEACHING LINE oie"No. & Length bf lines Total length/size ' <br /> FILTER BED [J Distance to nearest:: .s Well,>��� � -iundation t- � Property Line <br /> SEEPAGE PITS ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundatl'qn Property Line <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that t have prepared this application and that the, ork.w_ill be done in.accordance with San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin Local Health District..4i <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." Contractors 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 comgensa- <br /> tion laws of California." _ _ 4 <br /> The applica t mus all for req red in ctions. Complete drawing on reverse side.'" <br /> Signed X Title: Data: <br /> FOR PARTIW T USE ONLY �( <br /> Application Accepted by Date �U 4 AreayZ �T y <br /> Pit or Grout Inspection by Date Final Inspection by Dater�p <br /> Additional Comments: l <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 /> FEE INFO AMOUNT DUE AMOUNT REMITTED CK <br /> CASH RECEIVED BY DATE PERMIT'NO. <br /> + EH 13-241REV.1/s 5) l <br /> EH 14-26 <br />
The URL can be used to link to this page
Your browser does not support the video tag.