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88-742
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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SEVENTH
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15901
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4200/4300 - Liquid Waste/Water Well Permits
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88-742
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Last modified
12/16/2019 10:07:21 PM
Creation date
12/1/2017 8:45:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-742
STREET_NUMBER
15901
Direction
S
STREET_NAME
SEVENTH
STREET_TYPE
ST
City
LATHROP
SITE_LOCATION
15901 S SEVENTH ST
RECEIVED_DATE
3/31/88
P_LOCATION
JOSEPH L SIMONS
Supplemental fields
FilePath
\MIGRATIONS\S\SEVENTH\15901\88-742.PDF
QuestysFileName
88-742
QuestysRecordID
1921308
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT / <br /> 1601 E. HAZE 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 /> Q s z City Lot Size PM <br /> Job Address <br /> P Sa�7 Phone <br /> Owner's Name Address p <br /> yZ /� � Phone <br /> Contractor � Address License No, <br /> TYPE OF WELLIPUMP: NEW WELL ❑ WELL REPLACEMENT" LJDESTRUCTION D <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR D OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL F PROP. LINE <br /> FOUNDATION "'.AGRICULTURE WELL' ' O ELL tPITSISUMPS r <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRU SPECIFICATIONS <br /> El Industrial El Open Bottom [IManteca Oia ell Excavation Dia. of Well Casing <br /> ❑ DomesticlPtivate ❑ Gravel Pack ❑ Tracy ype-of Casing Specifications >� <br /> f l Public f} Other Cl De depth of Grout Seal Type of Grout n„ <br /> I I Irrigation �..Approx. Dept Eastern Surface Seal Installed by - `+\� <br /> Repair Work Done L] Type of Pu H.P. State Work Done <br /> ". C <br /> Well Destruction ❑ Well Diameter Sealing_ g Material (top 50'1 <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I'1 REPAIR/ADDITION [ I DESTRUCTIO (No septic system permitted it public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence — Commercial_ Other <br /> Number of'Iliving units: Number of bedrooms f <br /> Character of'-soil to a depth of 3 feet: C- Water table depth <br /> SEPTIC TANK ! Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENTYLT❑ „, Method of Disposal <br /> —Distance to nearest: Well . ,Foundation Property Line <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER SED ❑ Distance to nearest: Well Foundation. Property Line <br /> F <br /> SEEPAGE PITS I'I Depth Size Number <br /> SUMPS Ll Distance to nearest: Well Foundation Property Line <br /> i 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 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 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 applicant st call for all require inspections. Complete drawing on reverse side. <br /> Date: JSigned X - `" Title: <br /> ~•� �""� <br /> FOR DEPARTMENT USE ONLY r <br /> Application Accepted b <br /> Date 3-� Area <br /> f Pit or Grout Inspection by _ Date. Final Inspection by ate <br /> Additional Comments: U ~ <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Me eca 823-7104 ❑ Tracy 535-6365 <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 CASH RECEIVED BY DATE PERMIT'NO. <br /> -•y/, <br /> + EH 13INFO <br /> 24(REV.1/857 <br /> I EH 14-29 , <br />
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