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88-2344
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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88-2344
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Entry Properties
Last modified
12/6/2019 11:03:43 PM
Creation date
12/1/2017 11:24:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2344
STREET_NUMBER
1615
STREET_NAME
SUNSET
STREET_TYPE
AVE
City
TRACY
SITE_LOCATION
1615 SUNSET AVE
RECEIVED_DATE
09/09/1988
P_LOCATION
SALVADOR MENDOZA
Supplemental fields
FilePath
\MIGRATIONS\S\SUNSET\1615\88-2344.PDF
QuestysFileName
88-2344
QuestysRecordID
1939968
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 Nth'Lu__111 <br /> Telephohe (209) 466-6781 n \�,(� r <br /> PERMIT EXPIRES Y YEAR FROM DATE ISSUED <br /> f (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 /> 3'ob Address Ju/'�rET _,, CityurL.Lot Size PM <br /> SN–V rZ t r <br /> Owner's Name Address r�F S ET Phone 9cl�jJ e'.g <br /> Oontractor 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. POOP. LINE <br /> FOUNDATION AGRICULTURE WELL ELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA RUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Ma Dia. of Well Excavation Dia. of Well Casing t <br /> ❑ Domestic/Private ❑ Gravel Pack Trac Type of Casing Y Yp g � Specifications <br /> F] Public 171 Other ❑ Delta Depth of Grout Seal; Type of Grout <br /> y <br /> I I Irrigation .�..Approx. Depth I I Eastern Surface Seal Installed by i <br /> Repair Work Done Type of Pump H.P. State Work Done j <br /> Well Destruction ❑ Well Diametef Sealing Material (top 50') <br /> Depth Filler Material (Below 501 ( _ <br /> TYPE OF SEPTIC WORK; NEW INSTALLATION]7 REPAIR/,ADDITION I I DESTRUCTION/1 (No septic system permitted if public sewer is V <br /> available within 200 feet.) 1 <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 t J <br /> SEPTIC TANK ❑ Type/Mfg Capacity `" No. Compartments <br /> I <br /> PKG. TREATMENT PLT. ❑ t{,. 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 <br /> SEEPAGE PITS I I Depth Size Number <br /> SUMPS L1 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, I shall employ persons subject to workman's compensa- <br /> tion laws of C e—ia. <br /> TheaI' mu or all req "red inspections. Complete drawing on reverse side. <br /> s <br /> Signed X Title: _ Date: <br /> F R DEPARTMENT USE ONLY q o <br /> Application Accepted by aDQ. ate._l� 1" Area <br /> Pit or Grout Inspection by Date incl lnspe Bion by P -e- Date �rU <br /> Additional Comments: r� <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 EJ 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 /> INFO MOUNT DUE OUNT REMITTED 'CASH RECEIVED BY D TE PERMIT"NO. <br /> y <br /> S � z <br /> t.EH 13-241REV.1/x5) r <br /> EH 14-28 <br />
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