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87-3148
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4200/4300 - Liquid Waste/Water Well Permits
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87-3148
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Last modified
11/15/2019 10:07:31 PM
Creation date
12/1/2017 9:37:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-3148
STREET_NUMBER
16000
Direction
S
STREET_NAME
SIXTH
STREET_TYPE
ST
City
LATHROP
SITE_LOCATION
16000 S SIXTH ST
RECEIVED_DATE
08/20/1987
P_LOCATION
KAREN MEYER
Supplemental fields
FilePath
\MIGRATIONS\S\SIXTH\16000\87-3148.PDF
QuestysFileName
87-3148
QuestysRecordID
1926719
QuestysRecordType
12
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EHD - Public
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APPLICATION FOR PERMIT <br /> " SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA NOW <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1YEAR 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 /> Job Address 16000 6th Street City Lathrop Lot Size 50' x 100' PM <br /> Owner's Name Karen Meyer Address 370 L1, Main St., Mitntec8 Phone 239—1 74 <br /> Contractor Address License No. Phone_ <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 /> M Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout O <br /> I I Irrigation _-_Approx. Depth l I Eastern Surface Seal Installed by _ O <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done_ <br /> Well Destruction C Well Diameter Sealing Material (top 50') <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION i 1 REPAIR/ADDITION I I DESTRUCTION IX (No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence X Commercial_ Other <br /> iL Number of living units: 1 Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK :R Type/Mfg Cement Capacity unklalwn No. Compartments t <br /> f <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE 0 No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS I I Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ ^—�0 <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: "t 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 applicamust call for all required inspections. Complete drawing on reverse side. I <br /> Signed X. 0A Title: Date: 2 /aa 187 <br /> R DEKARTMENT USE ONLY A <br /> 1 Application Accepted -7by04Date l v Area 13 <br /> Pit or Grout Inspection by/ Date Final Inspection by to <br /> �_ <br /> � <br /> Additional Comments:� ,Zls;;I� <br /> ❑ Silk 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 95201 <br /> w <br /> CK 0 <br /> j INFO FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED 8Y DATE PERMIT'NO. <br /> t EH 13-24(REV.i/H s) <br /> EH 14-26 zyz 11 <br /> r <br />
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