My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-3978
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
S
>
SIXTH
>
15455
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-3978
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/22/2019 10:07:12 PM
Creation date
12/1/2017 9:35:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-3978
STREET_NUMBER
15455
Direction
S
STREET_NAME
SIXTH
STREET_TYPE
ST
City
LATHROP
SITE_LOCATION
15455 S SIXTH ST
RECEIVED_DATE
11/2/1987
P_LOCATION
LINDA STRICKLER
Supplemental fields
FilePath
\MIGRATIONS\S\SIXTH\15455\87-3978.PDF
QuestysFileName
87-3978
QuestysRecordID
1927293
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
APPLICATION FOR PERMIT L <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. 1662 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District./� , �+ <br /> Job Address . �� y,&ST ca ,, 5� City Lot Size. PM <br /> Owner's Name 41A4a,11 Address Phone <br /> Contractor Address License No. Phone .1 <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 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 f7 Other rl Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation —_Approx. Depth 1 ) 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 50'1 CJS <br /> Depth Filter Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I 1 1No 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 v <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 4— <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 I I Depth Size l <br /> Number <br /> SUMPS Ll Distance to nearest: Well Foundation r Property Line <br /> DISPOSAL PONDS ❑ <br /> f <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 alifornia." <br /> The applica must call for all required inspections. Complete drawing on reverse side. f <br /> Signed464,ne <br /> Title: Date: f <br /> T ENT USE ONLY <br /> Application Accepted by Date_ Area <br /> Pit <br /> Pit or Grout Inspection by Date Final Inspection by_01111e f r% Date <br /> Additional Comments: a <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 55201 <br /> FEE AMOUNT DUE AMOUNT REMITTED C F RECEIVED BY DATE PERMIT'NO. <br /> INFOEH 13-24 r1n +l 1 �+ n <br /> + EH 14-261REY.11fl 5r 25-oo _3 s-ov l��Z-�f7 6 7'-{-j7 r <br /> .J J r / 0 <br />
The URL can be used to link to this page
Your browser does not support the video tag.