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88-2390
EnvironmentalHealth
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26 (STATE ROUTE 26)
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24328
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4200/4300 - Liquid Waste/Water Well Permits
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88-2390
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Last modified
11/20/2024 8:49:22 AM
Creation date
12/2/2017 12:13:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2390
STREET_NUMBER
24328
Direction
E
STREET_NAME
STATE ROUTE 26
City
LINDEN
SITE_LOCATION
24328 E HWY 26
RECEIVED_DATE
9/13/1988
P_LOCATION
JOE ARMANINO
Supplemental fields
FilePath
\MIGRATIONS\T\26 (HWY 26)\24328\88-2390.PDF
QuestysFileName
88-2390
QuestysRecordID
1960538
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 /> Telephone (209) 466-6781 <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 Ordina a No:549 for sewage or No. 862 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. 0 <br /> Job Address <br /> ,� City Lot Size PM <br /> Owner's Name —k.�` ! Address Phone ! �+� <br /> Contractor ddress 4Wk2,Ql License No.&9VA Phone_ z <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION Cl <br /> PUMP INSTALLATION SYSTEM REPAIR OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS C <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> * Public n Other ❑ Delta Depth of Grout Seal Type of Grout _ <br /> ,kirrigation —.Approx. 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 Ie Sealing Material (top 50 <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I 1 DESTRUCTION 1 1 (No septic system permitted if public sew is <br /> available 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/MfgCapacity No. Compartments <br /> l. <br /> RKG. 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 a ❑ Distance to nearest: .Well Foundation Property line <br /> SEEPAGE PITS I I Depth Size .,,Number . <br /> SUMPS _ ❑ Distance to nearest: Well_ Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> 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 D3tri6t. - <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 equ'. I Completedawing on revers _ide. <br /> Signed X ills: <br /> �r� Date:Al <br /> FOR DEPARTMENT USE ONL <br /> Application Accepted by `Date AArea <br /> 02- <br /> Pit or Grout Inspection y Date Fina( Inspection by 2 f Date <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.D. Box 2009, Stk., CA 95201 <br /> INFO AMOUNT DUE AMO REMITTED CASH11 RECEIVED BY DATE PERMIT'NO. <br /> +.EH13-241REV.1i95) <br /> EH t1-28 <br />
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