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88-2595
EnvironmentalHealth
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STRATFORD
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14129
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4200/4300 - Liquid Waste/Water Well Permits
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88-2595
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Last modified
12/7/2019 10:53:04 PM
Creation date
12/1/2017 11:07:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2595
STREET_NUMBER
14129
Direction
S
STREET_NAME
STRATFORD
City
LATHROP
SITE_LOCATION
14129 S STRATFORD
RECEIVED_DATE
03/30/1988
P_LOCATION
DANIEL VIOLA MEJORADO
Supplemental fields
FilePath
\MIGRATIONS\S\STRATFORD\14129\88-2595.PDF
QuestysFileName
88-2595
QuestysRecordID
1937673
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION .FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT > { <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> r'. n <br /> Telephone (209) 466-67$1 <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. 1862 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. <br /> �i Jeb Address �1" City * Let Size f M <br /> Owner's Name /' 14. R d Address _ /'�/1 d 9 .Q /,f�.l Phone �� 3 <br /> IE <br /> Contractor 5-0— Address License No. Phone <br /> TYPE= OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> i <br /> DISTANCE TO NEAREST: SE�A NK SEWERLINES DISPOSAL FLD. PROP. LINE <br /> FOUND ATIO AGRICULTURE WELL OTHER WELL P1TSISUMPS <br /> INTENDED USE TYPE OF WELL PR AREA CON STRUCT( ICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑.Manteca eEl Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tr Type of Specifications <br /> I'1 Public ❑ Other f Delta y Depth of Grout Seal Type of Grout <br /> l t Irrigation _-Appro Depth I I 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') <br /> Depth 1 Filler Material (Below 50'1 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAIR/ADDITION I I DESTRUCTION INo septic system permitted if public sewer is_t <br /> vailable within 200 feet.) <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 ❑ 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 a Total length/size <br /> FILTER BED Cl Distance Ito nearest:-.. Weil Foundation Property Line <br /> SEEPAGE PITS 1-1 Depth I Size .Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ I <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: "4 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 California." <br /> The applicant r9ust,call for a( required inspections. Complete drawing on feverse side. <br /> Signed J Title: ._ �� 2.� Date: <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date Area <br /> Pit or Grout Inspection b Date Fina) Inspection by a Date, <br /> Additional Comments: �' L/ �ll� 1.- (J U' <br /> ❑ Stk 46676781 ❑ Lodi 369-3621 ❑ Mant ea 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 /> k } <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED CASK RECEIVED BY y��111 DATE PER <br /> +.EH13-24iREV.1iH51 - `v <br /> EH 14-2e I <br />
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