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87-825
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4200/4300 - Liquid Waste/Water Well Permits
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87-825
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Last modified
11/26/2019 10:11:18 PM
Creation date
12/1/2017 7:53:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-825
STREET_NUMBER
2319
STREET_NAME
SANGUINETTI
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
2319 SANGUINETTI LN
RECEIVED_DATE
3/19/1987
P_LOCATION
HERNANDEZ
Supplemental fields
FilePath
\MIGRATIONS\S\SANGUINETTI\2319\87-825.PDF
QuestysFileName
87-825
QuestysRecordID
1914699
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT / <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CAJ �GyR <br /> Telephone 12091 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. 1862 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. q t <br /> Job Address �3 L I� V �� ` City—�Stk Lot Size PM <br /> Owner's Name - - .1 �a���_ Address <br /> -.. Phone <br /> Contractor W� 1.�f Address r 4 License No.q .3 OAlPhone <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 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 /> ❑ Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout <br /> ❑ Irrigation ---Approx.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') <br /> Depth Filler Material Welow 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION is 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/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT- ❑ Method of Disposal r <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 Property Line <br /> SEEPAGE PITS ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: t-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 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 followig: "I certi at in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion laws o ifornia." <br /> applicant ust c all req red i spectio Co le rawing on r rse side. <br /> Signed X Title: Date: <br /> FO EPARTMENT USE ONLY <br /> Application Accepted by Date / � Area `� v <br /> Pit or Grout Inspection by Date Final Inspection by ro Date <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 .O 7xacyY935-M- <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 <br /> /DUE <br /> ^ AMOUNT REMITTED CK R RECEIVED BY DATE/ /PERMIT N0. <br /> EH 3-24{REV.iia51 �s`v� �2/'�'�r� '� /fJ [I �/s� y� V'�,�y�jC <br /> EH 14-28 ✓�I v /Cy � f 7J O O p(�J <br />
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