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88-1193
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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88-1193
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Last modified
11/28/2019 10:09:32 PM
Creation date
12/1/2017 9:35:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-1193
STREET_NUMBER
15523
Direction
S
STREET_NAME
SIXTH
STREET_TYPE
ST
City
LATHROP
SITE_LOCATION
15523 S SIXTH ST
RECEIVED_DATE
5/12/1988
P_LOCATION
CHARLES MYERS
Supplemental fields
FilePath
\MIGRATIONS\S\SIXTH\15523\88-1193.PDF
QuestysFileName
88-1193
QuestysRecordID
1927438
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL 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 hepeby 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 /> ^' <br /> Job Address Li `� a � CiLot Size PM <br /> Owner's Name Address Phone U / <br /> Contractor Addfess,;:2.5-736 A�_ O.�it /44-License NOL Phor� :slid <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 1:1DESTRUCTION ElPUMP INSTALLATION LJSYSTEM REPAIR LIOTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WEL - <br /> INTENDED USE TYPE OF WELL PROBLEM AREA C N SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Ma Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack Tracy Type of Casing Specifications <br /> FI Public ❑ 0 ❑ Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation —Approx. Depth l I Eastern Surface Seal Installed by _ <br /> Repair Wo ne ❑ Type of Pump H.P. State Work Done <br /> estruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth Filler Material IBelow 50') n <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION [1 REPAIR/ADDITION i I DESTRUCTIO {No septic system permitted if public sewer is <br /> available within 200 feet.) {, <br /> Installation will serve: Residence_ Commercial_ Other Vey <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 Disposal <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 A JI <br /> w <br /> SEEPAGE PITS i I Depth Size Number <br /> SUMPS Cl Distance to nearest: Well Foundation 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."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,1 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applican ust call for all requir d inspections. Complete drawing on revs side. <br /> Sig Title: 11" �Li.. Date: <br /> OR DEPARTMENT USE ONLY <br /> Application Accepted by G.,. r„ ; Date �a Area <br /> Pit or Grout Inspection by Data - Final Inspection by Date �ry <br /> Additional Comments: <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 95201FEE <br /> f <br /> INFO AMOUNT DUE AMOUNT REMITTED C K RECEIVED BY DATE PERMIT N0. fi <br /> + EH 13-241REV.ii 95] �i J <br /> EH 14-28 <br />
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