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89-1600 (2)
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4200/4300 - Liquid Waste/Water Well Permits
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89-1600 (2)
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Last modified
12/24/2019 10:06:41 PM
Creation date
12/1/2017 7:53:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-1600
STREET_NUMBER
2118
STREET_NAME
SANGUINETTI
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
2118 SANGUINETTI LN
RECEIVED_DATE
7/10/1989
P_LOCATION
NORENE DEITRICH
Supplemental fields
FilePath
\MIGRATIONS\S\SANGUINETTI\2118\89-1600.PDF
QuestysRecordID
1914668
Tags
EHD - Public
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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 District. <br /> Job Address 0"4-. City "".'�� Lot Size ,c"':' PM <br /> Owner's Name :1 Address Alec" Phone <br /> Contractor Address "7 1, i <br /> License No. ;t . "�. -y�- 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 FLO. PROP. LINE <br /> FOUNDATION A ICULTURE WE OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AftA C STRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom © Man-- -tee Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> M I Public ❑ Other F1 Del a th of Grout Seal Type of Grout—_ ------- <br /> I <br /> __ _.I I Irrigation —.Approx. Depth I I Del <br /> Surf Seal Installed by <br /> Repair Work Done 0 Type of Pump H.P. State Work Done <br /> Weil Destruction 0 Well Diameter Sealing Material tiop 501 <br /> Depth Filler Material (Below 501) __ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION} (NQ+depiic system permitted it public sewer is <br /> ,".a4ailable 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/Mfg Capacity No. Compartments <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 BED ❑ Distance to nearest: Well Foundation_ Progeny Line <br /> SEEPAGE PITS I I Depth Size Number <br /> SUMPS U 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 Dliltrict. <br /> Home owner or licensed agent's signature cenifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not <br /> employ any parson 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,1 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete drawing on reverse side. <br /> Signed Title: <br /> --rte vL. Date: <br /> OR DEPARTMENT USE ONLY <br /> Application Accepted by �I Date_ "',� Area 12l <br /> f <br /> Pit or Grout Inspection by Date Final Inspection by � ,! Data 7i <br /> Additional Comments:E) Stk 466-6781 Lodi 369-3 1 iameca 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 <br /> INFO CASH RECEIVED 0Y DATEPERMIT'NO. <br /> '- 3 V7, <br /> + EH 13-24(REV.fix5i t'•� C. <br />
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