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92-2640
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4200/4300 - Liquid Waste/Water Well Permits
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92-2640
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Entry Properties
Last modified
3/31/2020 10:04:55 PM
Creation date
12/1/2017 10:53:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
92-2640
STREET_NUMBER
14085
Direction
N
STREET_NAME
VINTAGE
STREET_TYPE
RD
City
LODI
SITE_LOCATION
14085 N VINTAGE RD
RECEIVED_DATE
07/22/1992
P_LOCATION
LOREN PERRY
Supplemental fields
FilePath
\MIGRATIONS\V\VINTAGE\14085\92-2640.PDF
QuestysFileName
92-2640
QuestysRecordID
1970386
QuestysRecordType
12
Tags
EHD - Public
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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O BOX 2009, STOCKTON, CA 95201 f <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED j <br /> (Complete in Triplicate) I1 <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described.' This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San } <br /> Joaquin County Public Health Services. r -� <br /> Job Address V� k City _., Lot Size/Acreage _ I <br /> Owner's Name tel. Address Phone <br /> Contractor ��C"2 Address - �0 — icpnse tVo. $ _Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C7 <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD, PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS T ' <br /> i <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS I <br /> n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing I <br /> 11 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications <br /> I'1 Public 1-1 Other 11 Delta f. Depth of Grout Seal Type of Grout <br /> I I tfrigation _Approx. Depth I I Eastern_ :,. Surface S'etll,installed by- -- r <br /> Repair Work Done L1 Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Welt Diameter Sealing Material & Depth <br /> Depth Filler Material & Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION, REPAIR/ADDITION I I DESTRUCTION l 1 (No septic system permitted if public sewer is <br /> �, available within 204 feet.l <br /> Installation will serve: Residence Commercial_ Other 1 x} <br /> Number of living units: -f------ Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANfC t Type/Mfg Capacity 49rup L No. Compartmisnts <br /> 1 <br /> PKG'}TH€ATMENT-PL-T. ❑ e x.j �- Method of Disposal <br /> Distance to nearest: t Well Foundation Property Line r <br /> LEACHING LINE No. & Length of lines ' Total length/size <br /> - i <br /> FILTER BED CJ Distance-to nearest. *etl "Foundation ,1.2 17--go Property Line <br /> SEEPAGE PITS I I y Depih Size Number 2 <br /> SUMPS L1 rDistance to nearest: Well >s"r Foundation.,� mss` 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 County <br /> Home owner or licensed agant's•iignature certifies the following: "I certify that in the performa'nco '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 lavrs,1of"CAlifornia." Contractor's hiring or sub-contracting signature <br /> certifies the followings "I certify that in the performance of the work for'which this permit is issued,)'shall employ persons subject to workman's compensa- <br /> tion laws of California." w 4 <br /> The applicant must call for require inspections. Complete drawing'on reverse side. <br /> 'Title; Date: <br /> Signed )( �� 1 / -_---} ------ <br /> i <br /> FQ8 DEPARTMENT USE ONLY � 2, j <br /> Application Accepted by Date `r�'�" �— Area L/ <br /> Pit or Grout Inspection by Date Final Inspection by Date 7^2 2' Z j <br /> r <br /> Additional Comments: <br /> Applicant - Return all copiesto: San Joaquin County Public Health Services <br /> Environmental Health Permit/Services ? <br /> 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 I <br /> FER AMOUNT DUE AMOUNT,REMITTEQ CKRECEIVED_BY_ _ ... DATE- • - •PERMIT'NO: - <br /> INF ' <br /> _ - - - <br /> t. EH 13-24 IREV.i i n 5i" - `.. �....--�-ViI <br /> /� �, <br /> EH 14.25 I <br />
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