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92-0363
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4200/4300 - Liquid Waste/Water Well Permits
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92-0363
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Last modified
3/24/2020 10:11:33 PM
Creation date
12/1/2017 11:14:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
92-0363
PE
4364
STREET_NUMBER
11669
Direction
E
STREET_NAME
SUN
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
11669 E SUN RD
RECEIVED_DATE
03/02/1992
P_LOCATION
ARTHUR C NAFTEL
Supplemental fields
FilePath
\MIGRATIONS\S\SUN\11669\92-0363.PDF
QuestysFileName
92-0363
QuestysRecordID
1938583
QuestysRecordType
12
Tags
EHD - Public
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C <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> III, ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O BOX 20092 STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> I (Complete in Triplicate) <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County`Public Health Services. <br /> Job Address `,f�6 �P �6y City! Lot Size/Acreage �� e <br /> Owner's Name K/�R`✓� � ` Address w5fldll� /Crs�Sd Phone <br /> Contractor CLI M Address License No. Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR. ❑ OTHER ❑ Monitoring Well C� <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'rSPECIFICAT10NS <br /> CI Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation + Dia. of Well Casing <br /> [I Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications <br /> I'1 Public Cl Other n Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation _.Approx. Depth I I Eastern Surface Seal Installed-by <br /> Repair Work Done U Type of Pump H.P. State Work Done_ <br /> Well Destruction ❑ Well Diameter Sealing Material & Depth,— --^^ —~-- - <br /> ON! <br /> Depth Filler Material & Depth � <br /> • <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION ( I DESTRUCTION I INo septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial_ Other r <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water-table-depth--- <br /> SEPTIC TANK. D Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. 0 Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE Cl No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS 11 Depth Size Number <br /> SUMPS - LI Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that 1 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 County <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 California." <br /> The applicant must call.for all required inspections. omplete drawing on reverse side. <br /> Signed X Title: �._ Date: ' <br /> F DE ARTMENT USE ONLY I <br /> t I <br /> Application Accepted by � Date y 'I-- Area r <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> Additional Comments: <br /> i <br /> Applicant - Return all copies to: San Joaquin County Public Health Services <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> FEE INFO AMOUNT DUE AMOUNT REMITTED CK CASH RECEIVED BY DATE PERMIT'NO. <br /> . EH 13.211REV.,in51 j\ �.�l / v^� / CJ, r T-- 7 O G�^ 6^� <br /> EH N-2e V t®�J V 17 7/ I —I� �`( �_ `L .J� <br />
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