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87-4000
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SNYDER
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4200/4300 - Liquid Waste/Water Well Permits
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87-4000
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Last modified
11/22/2019 10:06:58 PM
Creation date
12/1/2017 9:54:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-4000
STREET_NUMBER
2300
STREET_NAME
SNYDER
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
2300 SNYDER LN
RECEIVED_DATE
11/3/87
P_LOCATION
JOHN HARRISON
Supplemental fields
FilePath
\MIGRATIONS\S\SNYDER\2300\87-4000.PDF
QuestysFileName
87-4000
QuestysRecordID
1929021
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E._AAZELTON AVE., STOCKTON, CA <br /> fi Telephone (209) 466-6781 <br /> I/PERMIT EXPIRES TYEAR FROM DATE ISSUED he"- kl"�-x r <br /> (Complete in Triplicate) ifs <br /> the <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install work herein described. This application is G€ <br /> made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and tfiie Rules and Regulations of the San Joaquin <br /> Local Health District. ! <br /> Job Address <br /> �a City �/ Lot Size PM <br /> .� Address Phone <br /> Owner's Nam ___ I� <br /> 1117 11� <br /> Contractor Address License K Phone <br /> TYPE OF WELL/PUMP: NEW WELL �4— WELL REPLACEMENT ❑ -DESTRUCTION—Li— <br /> . <br /> PUMP INSTALLATION SYSTEM REPAIR ❑ I� OTHER ❑ ,Arte� <br /> O f DISPOSAL FLD. PROP. LINE !� <br /> DISTANCE TO NEAREST: SEPTIC TANK �----- <br /> SEWER LINES <br /> FOUNDATION _-- AGRICULTURE WELL OTHER WELL PITS/SUMPS f . <br /> 1 O <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS` <br /> ❑ Industrial pen Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing Q i <br /> El YP 9 <br /> T e of Casin �� Specifications <br /> mastic/Private ❑ Gravel Pack <br /> FI Public F1 Other f Cl Delta Depth of Grout Seal Type f Grout <br /> I 1 Irrigation __.Approx. Depth I I astern Surface Seal Installed by- <br /> 4 <br /> Repair Work Done ❑ Type of Pump H.P. — State Work one <br /> 11 <br /> Well Destruction ❑ Well Diameter Sealing Material Stop 50'1 <br /> Filler Material (Below 50'1 I�"---- <br /> Depth � <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIKIADDITION ! I DESTRUCTION I I (No sea ptic system <br /> m rented if public sewer is <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 F) Type/Mfg Capacity �No"Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation <br /> s Property Line <br /> ,I - <br /> LEACHING LINE ❑ No. a Length of lines Total length/size <br /> f � <br /> FILTER BED ❑ Distance to nearest: Well Foundation Prope6 Line f <br /> f. <br /> SEEPAGE PITS I i Depth Size Number <br /> SUMPS LJ Distance to nearest: Well Foundation Property Liner <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sian Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin Local Health District- II <br /> that in the performance of the work for which this permit is issued, I shall not <br /> Home owner or licensed agent's signature certifies the following: "I certify <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractors 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 eritploy persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant m call for all required inspections. o plete drawing on reverse side. i <br /> Signed X <br /> Title: Date: <br /> –4— <br /> F1 EPARTMENT USE ONLY <br /> Application Accepted by Date '1"A' Area <br /> CPit or Grout Inspection by Date 11 Final Inspection by Date <br /> M I� <br /> 1 Additional Comments: <br /> i <br /> ElStk 466-6781 ElLodi 369-3621 ❑ Manteca 823-7104 D Tracy 835-638511 <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., PA. Boxy, Sik.,'.CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTEl7 K H RECEIVED BY I DATE PERMIT'NO. <br /> INF 1 <br /> + EH 13.24 iREV.t/H 51 <br /> EH 14-26 I� �— _ 5 <br />
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