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SU0004721
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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88 (STATE ROUTE 88)
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4426
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2600 - Land Use Program
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PA-0400643
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SU0004721
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Entry Properties
Last modified
11/20/2024 9:24:11 AM
Creation date
9/4/2019 6:24:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004721
PE
2631
FACILITY_NAME
PA-0400643
STREET_NUMBER
4426
Direction
E
STREET_NAME
STATE ROUTE 88
City
STOCKTON
APN
10102158
ENTERED_DATE
11/24/2004 12:00:00 AM
SITE_LOCATION
4426 E HWY 88
RECEIVED_DATE
11/23/2004 12:00:00 AM
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\E\HWY 88\4426\PA-0400643\SU0004721\EH PERM.PDF
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EHD - Public
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APPLICATION FOR WELLIPUMP PERMIT <br /> ;AN JOAQUIN COUNTY PUBLIC HEALTH SERVICII i <br /> 1v. ENVIRONMENTAL HEALTH DIVISION <br /> P,0, BOX 388, 904 EAST WEBER AVENUE, STOCKTON, CA VMi,388 <br /> (209) 468.3420 <br /> EFUN61C9L EitMIT €XPIRES f YEAR F_DATE ISSUED <br /> TIComp6to ID Trip#Ir*t*► OPIA-1 <br /> DE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOn INSTALL THE WORK DESCRIBED.THISE MAL WtrH SAN <br /> APPLICATION IS ER Y CES EN' Of ALTH OtVISION. <br /> JOAQUIN COU DEVELOPMENT TRLE.CHAPTER 9-1 115.3 AND THE STANOAROS OF SAN JOAQUIN COUNTY PUBL((IICCrrHEEALTH SERVI <br /> JOB ADDRESSMA APN! d Z I 7 --]1 _ CITY 1�4P" PARCEL StZEIAPNR D ?6 1 7 z aC <br /> OWNER'S NAME ^rAna.v aM.rt� L/(�.. T /' ADDRESS S�rAl. 't 'G �i-P`Ic. ' Y0 PHONE r f6-7 3z <br /> CONTRACTOR Q I t�TEC_ L ___ _- ADDAISS I.• VC, 1� LICr�IO�7�� PHONE I�IIa a r7ZCsZ- <br /> OUR CONTRACTOR ADDRESS UC# PHONE <br /> TYPE OF WELL/PUMP: ❑ NEW WELL ❑ REPLACEMENT WELL ❑TMONITORING WELL a ❑ OTHER `-- <br /> ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CnO43-CONNECY REPAIR ❑ VAPOR EXTRACTION WELL E—_ J I <br /> ❑New❑Remelt H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL 0 <br /> HYPE OF PUMPI <br /> ❑ OUT-OF-SERVICE WELL ❑ OEOPLLVSICAI.WELL I � 80tL 80RING,.--. ef'f• -_ B <br /> ❑DESTRUCTION: <br /> INTENDED US E TYPE DF <br /> WELL CONSTRUCTION SPECIFICATIONS � A <br /> 1 l <br /> ❑ INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION el DIA.OF CONDUCTOR CASING D I <br /> ❑ DOMESTIC/PREVATE ❑GRAVEL PACKISIZE TYPE OF CARINGI5TFE1./PVC DIA,OF WFLL CASING D <br /> ❑ FUBUCIMUNICIPAL p❑�DRIVEN'F'y-c. I DEPTH OF GROUT SEAL SPECIFICATION K <br /> ❑ IRRIOA71OWAG K7 OTHER 5•'T bo),1 A, GROUT SEAL-INSTALLED BY �cl.�`�'F•�-G� f M- GROUT BRAND HAME 40 I e i- jEIN. <br /> ❑ MOINTOntNG GROUT-SEAL PUMPED: ©Yee [IN. CONCRETE PEDESTAL BY DRILLER:11EI Na S <br /> ! � I I <br /> APPMX.DEPTH (� — ZO - - LOCKING CHESTER BOXISTOVE PIPE S <br /> PROPOSED CON*TRUCTIONIDIMLUNQ METHOD; MUD ROTARY AIR ROTARY AUGER� CABLE OTHER <br /> 1 HE9E8Y CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL SE DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES,STATE LAWS,AND RULES ANO <br /> REGULATIONS OF TILE SAN JOAOUIN COUNTY. HOME OWNER OR LICENSED AGENT'$SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> 71416 PERMIT IS ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTAACTOR'S HIRING OR BUB-CONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: '1 CERTIFY THAT 1N TILE PERFORMANCE OF THE WORK Pon WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF <br /> CALIFORNIA.- THE APPUC NT MUST CALL 24 HOURS 1N ADVANCE FOR ALL REQUIRED INSPECTION*AT f2001480'"22. COMPLETE DRAWING AT LOWER AREA PROVIDED. �y <br /> 81*ned X 1 , T1t1e `f Af c. a,ci 1 Ct,,,'7 hJ 7L --- - De (�C? <br /> PLOT PLAN(Drew.to Seidel Raffle to <br /> USE BEWAG <br /> F H <br /> OOE.DIBI�8AL BY8TEM On PROPOSED <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATIONr•+. � <br /> 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL BYBTEMS. R� <br /> 3, DIMENSIONED OUTLINES AHD LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WFTHIN RADIUS OF ONE HUNDRED FIFTY FT. !� <br /> STRUCTURES.INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. - ON THE PROPERTY OR ADJOINING PROPERTY. <br /> . S <br /> �- La <br /> _' <br /> Irl - <br /> o, <br /> j•I 1� 'r .. '' � ' - - ,���ja�jydy/ .yco�' � <br /> C,� �, ti+9 Tru q ri rod •Z <br /> 3.j `/ F0 .o l.-4 ka. 42' QQ <br /> ..,.,.. ..... V.. ... <br /> -GZL o c` �^ 'aw`.., <br /> c•) ?'`: <br /> :oat /L� �r } 3rd fyW XT 2'31'35'E ` N,32 <br /> r �'D N N <br /> Qrq <br /> . � �- DEPARTMENT USE ONLY <br /> Ar <br />,.=w=-ApPlleerien-Aeeepted-By"�^". - "�", <br /> Gre.n lmpeellen By 'w Oate Pump Inmp-tlen By Date <br /> Oeedreaien tnrpeeilosi By=_ Des <br /> Cemmerlte: _3- j <br /> (42 <br /> ACCOUNTING ONLY: AIDR FACd <br /> PE CODES FEE INFO AMOUNT REMIT? CHECK CA8H RECEIVED BY DATE PEfiMITISUMCE REQUEST NUMBER INVOICE <br /> c5 �1 q <br /> Pub.Health Serv.-Enviro.173(3198) R • r <br />
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