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88-1281
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4200/4300 - Liquid Waste/Water Well Permits
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88-1281
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Last modified
11/29/2019 10:05:35 PM
Creation date
12/1/2017 5:52:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-1281
STREET_NUMBER
832
STREET_NAME
PLEASANT
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
832 PLEASANT AVE
RECEIVED_DATE
5/23/1988
P_LOCATION
LOUIS DELUICCHI
Supplemental fields
FilePath
\MIGRATIONS\P\PLEASANT\832\88-1281.PDF
QuestysFileName
88-1281
QuestysRecordID
1900336
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT 11 <br /> -A.L <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT w � <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. <br /> Job Address 2— ty Lot Size PM <br /> ��L' <br /> Owner's Name JAddress t Phone <br /> t <br /> Contractor Y License NA Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ 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 ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> r v - <br /> 1`1 Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout _ <br /> I I Irrigation Approx. Depth I I Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.P. I State Work Done_ <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth Filler Material (Below 501 l] <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 11, REPAIR/ADDITI N I i STRUCTION I 1 (No septij system permitted if public sewer is <br /> vailable ithin 200 feet.) (� ] <br /> Installation will serve: Residence_ Commercial_ Other }�✓ <br /> Number of living units: Number of bedrooms r c <br /> Character of soil to a depth of 3 feet: t 4&1,� . .depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ ' Method of Disposal <br /> r E Distance to nearest: Well Foundation Property Line <br /> i <br /> LEACHING LINE ❑ No. & Length of lines _ _ __ I Total length/size T� <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property,Line <br /> SEEPAGE PITS 1 ) Depths ._ Size Number <br /> SUMPS 0 Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> 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 cornpensa- <br /> tion laws of.California." <br /> i <br /> Theapplicantrstcall for all to aired ins tions. Complete drawing on reverse side. <br /> 1 V <br /> 5ignad X Title: Date: <br /> -t <br /> FOR DEPARTMENT USE ONLY <br /> r'Application Accepted by Date 7 Area <br /> Pit or GroutInspectionby Date Final Inspection by (reN.il/" DateJ. 4 <br /> Additional Comments: t1 t l f <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, Sik., CA 95201 <br /> kFEE Q�AMOUNT DUE— MOUNT. ASU 41 ,~_RECEIVED BY. _DATE. PERMIT-NO. <br /> a EH 13-24(REV.1/n s) j,j.J ``��/ .ls/Y� � �' 0 4W <br /> EH 14-26 1/��fWUi <br />
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