My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
88-2110
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
R
>
RHODE ISLAND
>
1324
>
4200/4300 - Liquid Waste/Water Well Permits
>
88-2110
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/4/2019 10:13:26 PM
Creation date
12/1/2017 6:49:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2110
STREET_NUMBER
1324
STREET_NAME
RHODE ISLAND
City
STOCKTON
SITE_LOCATION
1324 RHODE ISLAND
RECEIVED_DATE
8/17/88
P_LOCATION
RODERICK SPEARS
Supplemental fields
FilePath
\MIGRATIONS\R\RHODE ISLAND\1324\88-2110.PDF
QuestysFileName
88-2110
QuestysRecordID
1907928
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
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 7 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. 1662 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. <br /> Job Address U Cit Lot Siie PM <br /> Owner's Name Address _ p Phone i <br /> Contractor Address License No. — 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 /> f'l Public II Other ❑ Delta Depth of Grout Seal : Type of Grout _ <br /> I I irrigation --Approx. Depth ( I 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 501 <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I:I REPAIR/ADDITION t I DESTRUCTION No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence Commercial_ Other C <br /> Number of living units:- Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK IS— Type/Mfg Capacity 10C20 No. Compartments <br /> PKG, TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation A Property Line <br /> LEACHING LINE liaNo. & Length of lines Notal length/size <br /> FILTER BED IPL Distance to nearest: Well .Foundation Property Line r` <br /> SEEPAGE PITS Depth Size . Number ! _ <br /> SUMPS L7 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, I shalt 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 applica must fo&lf r quir d 'inspections. Complete drawing on reverse side. Q <br /> Signed X Title: eI� Date:, <br /> f FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date Area_ <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> Additional Comments: 69 W <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 <br /> INFO AMOUNT DUE AMOUNT REMITTED fCK�H/ RECEIVEDBY D-7ATTEr{� PERMIT*NO. <br /> +.EH 13.24(A5v.1iµ5) <br /> 01 1428 <br /> "a�' <br />
The URL can be used to link to this page
Your browser does not support the video tag.