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89-916
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QUASHNICK
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4200/4300 - Liquid Waste/Water Well Permits
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89-916
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Last modified
1/10/2020 10:15:23 PM
Creation date
12/1/2017 6:15:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-916
STREET_NUMBER
5479
Direction
E
STREET_NAME
QUASHNICK
STREET_TYPE
RD
City
STOCKTON
APN
08666024
SITE_LOCATION
5479 E QUASHNICK RD
RECEIVED_DATE
04/26/1989
P_LOCATION
MORADA ESTATES NORTH
Supplemental fields
FilePath
\MIGRATIONS\Q\QUASHNICK\5479\89-916.PDF
QuestysFileName
89-916
QuestysRecordID
1904022
QuestysRecordType
12
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EHD - Public
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� � 1 <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 1601 E. HAZEL 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 Di t. &60-2-1/ <br /> _ 0-2-1/ <br /> :.0 <br /> Job Address City '-^ Lot Size PM <br /> Owner's Name r /` Address Phone <br /> 4/ 4KU=) <br /> ContractorAddressP�eIcense No. Phone :I <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 171 DESTRUCTION <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP, LINE I <br /> I <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 /> 71 Public ❑ Other Ll Delta Depth of Grout Seal ' Type of Grout��� v <br /> i I Irrigation _-Approx. Depth i I Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done <br /> Well Destruction ❑ ,Nell Diameter Sealing Material )top 50'1 <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION l I DESTRUCTION 1 INo 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 /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/IIlfg Capacity No. Compartments �s <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 RED El Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS I 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 Di?trict. <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, 1 shall not <br /> employ any person in such manner as to ecome subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> certifies the fol wing: "I cerAthatj.pitirmomn <br /> eforance of the work for which this permit is issued,1 shall employ persons subject to workman's compensa- <br /> tion laws of onia."The appli ust call for s,,Complete drawing on re se side. <br /> S Title: _—ff-W Date: <br /> FOR rRTMEPTy ONLY �y <br /> Application Accepted by Date Area <br /> Pit or Grout Inspection by Date Final Inspection by Date <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 /> FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT'NO. <br /> INFO <br /> +.EH 13-24(REV.I?n 5) S ` p 0 /110 1 <br /> EH 14-26 <br />
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