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88-517
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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88-517
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Entry Properties
Last modified
12/14/2019 10:10:59 PM
Creation date
12/1/2017 8:28:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-517
STREET_NUMBER
3458
STREET_NAME
SECTION
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
3458 SECTION AVE
RECEIVED_DATE
3/11/88
P_LOCATION
RICARDO SUAREZ
Supplemental fields
FilePath
\MIGRATIONS\S\SECTION\3458\88-517.PDF
QuestysFileName
88-517
QuestysRecordID
1919451
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON 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 3{f ��� ��� f�A`) City SzK� Lot Size G�Xy6 PM <br /> Owner's Name <br /> Z— Address /SO f ri�4:� Phone <br /> Contractor r4-d:7y.0 E- Grl4oe Z� Address 7 Al �_ License No. 7- Y, 4 Phone 57 <br /> ZZ <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 0 D 'CTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WEL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA STRUCTION SPECIFICATIONS <br /> Li Industrial LIOpen Bottom (71Manteca Dia- of Well Excavation, Dia. of Well Casing <br /> ❑ Domestic/Private Cl Gravel Pack ❑ Tracy Type of Casing Specifications <br /> ['1 Public ❑ Other CI Del Depth of Grout Seal Type of Grout <br /> I I Irrigation --Approx. Depth l I astern 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 f <br /> Depth Filler Material (Below 501 <br /> 4 TYPE OF SEPTIC WORK: NEW INSTALLATION {.I.-REPAIR/ADDITION 1 1 DESTRUCTION (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve:. Residence t 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 DisposalIV A <br /> lCistance to nearres^ t s Well t Foundation Property Line R' <br /> LEACHING,LINE -❑, No. & Length_of_lines Total length/size <br /> FILTER BED �Ie, ❑ Distance to nearest: Well Foundation Property Line <br /> a <br /> SEEPAGE PITS t . Depth $ J Size Number <br /> SUMPS 13 Distance'to nearest: Well Foundation 1 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." Contractors 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 i shall employ persons subject to workman's compensa- <br /> tion laws of California." I I <br /> The applicant must call for all required inspections omplete drawing on reverse side. <br /> Signed Title: Date: - /V"� -- <br /> I f <br /> FOR DEPARTMENT USE ONLY K <br /> Application Accepted by Date Area <br /> � J <br /> Pit or Grout Inspection by paleFinal Inspection by �.. Date—. <br /> ate <br /> Additional Comments: <br /> El Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 El 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 SH RECEIVED BY DATE PERMIT*NO. <br /> INFO t <br /> 1 + EH 13-24 1 REV.I/A 5) <br /> I EH 14-29 <br />
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