My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-672
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
T
>
26 (STATE ROUTE 26)
>
11069
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-672
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/20/2024 8:49:22 AM
Creation date
12/2/2017 12:03:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-672
STREET_NUMBER
11069
Direction
E
STREET_NAME
STATE ROUTE 26
City
STOCKTON
SITE_LOCATION
11069 E HWY 26
RECEIVED_DATE
03/11/1987
P_LOCATION
WATSON SCOFFIELD
Supplemental fields
FilePath
\MIGRATIONS\T\26 (HWY 26)\11069\87-672.PDF
QuestysFileName
87-672
QuestysRecordID
1958875
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
View images
View plain text
r <br /> r APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE i ON AVE., STOCKTON, CA MAR 9 1987 <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIROMENTAL HEALTH <br /> (Complete in Triplicate) '. PERMIT/SERVICES <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 /> d goy _ . - h <br /> Job Address //[/ � ��i� City Lot Size PM <br /> Owner's Name � � T N i Address 4_V"7� Phone <br /> Contractor Address LIa&C�4J P, -License No. A�Fz1g�, Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION PC SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> - —= FOUNDATION- 4 AGRICULTURE WELL- OTHER WELL <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> �7 <br /> Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> ❑ Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout <br /> ❑ Irrigation --Approx. Deptth'�tt❑ Eastern Surface Seal Installed by <br /> Repair Work Dome ❑ Type of Pump H.P.�>� State Work Done 1p <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501Q ELfm Alm_ i �� k7 <br /> i <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is <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 <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 Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> n <br /> SEEPAGE PITS ❑ Depth # Size Number . <br /> "-SUMPS r ❑:�Distance_to nearest: Well ,- Foundation Property-Line = = : J-13 <br /> _, <br /> DISPOSAL PONDS ❑ 1 # <br /> I hereby certify that I have prepared this application and that the work will be done in accordance wit I San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin Local Health District. g <br /> Home owner or licensed agent's signature certifies the following: "I certify that in the performancelof 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 Califo'rnia."Contractor's hiring or sub-contracting signature <br /> certifies the following:"I certify that in the performance of thii-work for which this permit is issued,I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> f'r <br /> The applicant m t fo all re it d inspections. Complete drawing on Lever side. <br /> -. <br /> f t � y i <br /> Signed X j itle: �� ra Date: <br /> i L —FOR DEPARTMENT USE ONLY <br /> Application Accepted by { Date 3 J l/ <br /> 1�4- 7 Area <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> AdditionalT Comments: 4 <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104`� ❑ Tracy 835-635,5 <br /> Applicant. Return all copies to: Environmental Health Permit/Services=1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE <br /> INFO AMOUNT DUE J AMOUNT REMITTED -. BASH, : �.RECEIVED BY DATE PERMIT'N0. <br /> + EH 13-241REV.1/e 5) Y <br /> EH 14-26 :5 • O,3 <br />
The URL can be used to link to this page
Your browser does not support the video tag.
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).