My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
72-112
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
T
>
TRACY
>
3775
>
4200/4300 - Liquid Waste/Water Well Permits
>
72-112
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/1/2019 10:30:09 PM
Creation date
12/2/2017 1:38:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-112
STREET_NUMBER
3775
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
SITE_LOCATION
3775 TRACY BLVD
RECEIVED_DATE
03/31/1972
P_LOCATION
STANDARD OIL
Supplemental fields
FilePath
\MIGRATIONS\T\TRACY\3775\72-112.PDF
QuestysFileName
72-112 (2)
QuestysRecordID
1950225
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
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).
View images
View plain text
4 FOR OFFICE USE: APPLICATION FOR WELL OR PUMP PERMIT PERMIT N0. <br /> (Complete in Triplicate) Date Issued: <br /> "r HIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED - <br /> t x <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN LOCAL HEA <br /> LTH DISTRfCT THE WORK STATED HEREON. THIS APPLICATION IS MADE IN COMPLIANCE WITH FCOUNTY ORDOR AI NANCEERFORM <br /> NO. 1862 AND RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT, <br /> JOB ADDRESS/LOCA ON: <br /> OWNER'S NAME: CENSUS TRACT: <br /> ADDRESS: PHONE,Y/f� - b <br /> CONTRACTOR'S NAME: CITY: <br /> LICENSE # PHONE: �f / <br /> INTENDED USE: INDIVIDUAL DOMESTIC WATER WELL /- /_r PUBLIC WATER WELL 2 TEST WELL /_7 <br /> IRRIGATION/LIVESTOCK/AGRICULTUTRAL'WATER WELL- - INDUSTRIAL:-WATER=WELL-%/_;" <br /> CATHODIC PROTECTION WELL / / GEOPHYSICAL WELL / / OTHER / <br /> NEW WELL: DISTANCE TO NEAREST: SEPTIC TANK 14ra SEWER LINES .PIT PRIVY <br /> SEWAGE DISPOSAL FIELDCESSPO L SEEPAGE PIT OTHER `aL t'104. TA a S e <br /> k - <br /> REPAIRS: TYPE OF REPAIRS: cJ�j <br /> +_j <br /> ABANDONMENT/DESTRUCTION: METHOD TO BE USED: ay <br /> IP <br /> PLOT-PLAN: SHOW ON REVERSE SIDE -_ { <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN k <br /> ACCORDANCE WITH THE PROVISIONS OF THE LAWS OF THE STATE OF •CALIFORNIA, .THE ORDINANCES OF THE <br /> COUNTY OF SAN JOAQUIN, AND THE RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> SIGNED <br /> CONTRACTOR: <br /> PHASE I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: AT <br /> ADDITIONAL COMMENTS: <br /> PHASE II PHASE III FI AL <br /> f <br /> INSPECTION BY: .� DATE I r/'Y INSPECTION BY: DATE p2 <br /> E H 1426 SAN JOA UIN LOCAL HEALTH DISTRI <br /> DISTRIBUTION: WHITE-HEALTH DISTRICT - YELLOW-PROPERTY OWNER - PINK-CONTRACTOR I/72 7M <br />
The URL can be used to link to this page
Your browser does not support the video tag.