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87-1489
EnvironmentalHealth
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SEVENTH
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4200/4300 - Liquid Waste/Water Well Permits
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87-1489
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Last modified
9/13/2019 9:53:29 AM
Creation date
12/1/2017 8:48:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-1489
STREET_NUMBER
24
Direction
W
STREET_NAME
SEVENTH
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
24 W SEVENTH ST
RECEIVED_DATE
04/21/1987
P_LOCATION
MIGUEL A SALCEDO
Supplemental fields
FilePath
\MIGRATIONS\S\SEVENTH\24\87-1489.PDF
QuestysFileName
87-1489
QuestysRecordID
1920963
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION,FOR PERMIT <br /> I .t. _ e <br /> SAN JOAQUIN'LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781VI <br /> NlO <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. 5 <br /> r� „ W <br /> Job Address L� - _ City Lot Size 4�U x 0 J PM <br /> Owner's Name L Address d w . 7 Th S T Phone 416 <br /> Contractor ✓U `-'F Address License No. Phone ' <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR Cl 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 /> ❑ Public ❑ Other - ❑ Delta Depth of Grout Seal Type of Grout <br /> ❑ Irrigation -L—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 Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑_ REPAIR/ADDITION ❑ DESTRUCTION (No septic 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 O' Type/Mfg Capacity No. Compartments <br /> PKG, TREATMENT PLT. 0 Method of Disposal <br /> Distance to nearest: Welles- Foundation Property Line <br /> LEACHING LINE ❑ No. & Length of lines 4 Total length/size <br /> FILTER BED ❑ Distance to nearest: s Well - Foundation Property Line <br /> SEEPAGE PITS ❑ Depth Size Number 1 a' <br /> SUMPS Cl Distance to nearest: Well Foundation Property Line , <br /> rr <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 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 must call for all required inspections. Complete drawing on reverse side. ....2 <br /> 4-Signed X Title: 4 a „r_ve '` <br /> 1 <br /> Date: <br /> FO DEPARTMENT USE ONLY <br /> Application Accepted by r Date Area O 1 <br /> Pit or Grout inspection by Date Final Inspectionby <br /> Date <br /> Additional Comments - Jd — <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Mantec 823-7104 ❑ Tra4 835-6385 <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> �' INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE JPERMII'NO. <br />
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