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90-2711
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TOKAY COLONY
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11850
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4200/4300 - Liquid Waste/Water Well Permits
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90-2711
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Last modified
2/27/2020 10:15:56 PM
Creation date
12/2/2017 1:18:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-2711
STREET_NUMBER
11850
STREET_NAME
TOKAY COLONY
City
LODI
SITE_LOCATION
11850 TOKAY COLONY
RECEIVED_DATE
10/08/1990
P_LOCATION
ALOIS BUCHER
Supplemental fields
FilePath
\MIGRATIONS\T\TOKAY COLONY\11850\90-2711.PDF
QuestysFileName
90-2711
QuestysRecordID
1947885
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE'_TON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 'I'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 Sa oaquin County Ordin n e N�549 fQrr ssey age of No. 1862 for well/pump and the Rules and Regulations of the San Joaquin i <br /> Local Health District. �`JJ <br /> 1 E 6 T� <br /> Job Addre <br /> City Lot Size PM ., <br /> C.] A -P C 1 <br /> Owner's Name l- Address Ll TO Phone <br /> Contracto&4gy�Z UQv Address �"��`' Lscense No.S�I6 Phone s P <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION SYSTEM REPAIR ❑ OTHER O <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> i <br /> 0 <br /> � _" " INTENDED-USE=S ;TY-PE 01`WELL. .- PR08LEMAREA. _CONSTRUCTION SPECIFICATIONS + <br /> L] �ridustrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of(Nell Casind <br /> -7/Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> I'] Public l7 Other ❑ Delta Depth of Grout Seal Type of Grout _ <br /> i <br /> I i Irrigation `.---Approx. De{th l 1 Eastern Surface Seal Installed by - <br /> Repair Work Done ❑ Type of Pump H.P. 14 5 State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I:] REPAIR/ADDITION I ] DESTRUCTION I I (No septic system permitted if public sewer is <br /> available within 200 feet.I I <br /> i <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 L1 No. R Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS l I Depth Size Number <br /> SUMPS Ll Distance to nearest: Well Foundation Property Line <br />�� DIS-POSAL PONDS '""❑r - -- �-` TM T - - - - - <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 California." <br /> The applicant m t call for all req u' ins coons. Complete drawing on reverse side. <br /> Signed X Title: <br /> Date: <br /> 67 R DEPARTMENT USE ONLY—— 7 <br /> Application Accepted by Date 10 ^ �q L� Area __�}}� <br /> Pit or Grout Inspection by Date Final inspection by 6. Date A�126 d <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.O. Box 2009, Stk., CA 45201 <br /> FEE AMOUNT DUE NT REMITTED CASH CK RECEIVED BY DATE PERMIT-NO. <br /> r INFO I <br /> +-EH 1324(REV.1/H51 �� t 17-07rJ—�'�f.C7EH7428 <br />
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