My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SU0003878
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
H
>
HENRY
>
9791
>
2600 - Land Use Program
>
PA-0300217
>
SU0003878
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/7/2020 11:30:12 AM
Creation date
9/5/2019 11:16:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0003878
PE
2622
FACILITY_NAME
PA-0300217
STREET_NUMBER
9791
Direction
S
STREET_NAME
HENRY
STREET_TYPE
RD
City
FARMINGTON
APN
20707008
ENTERED_DATE
5/11/2004 12:00:00 AM
SITE_LOCATION
9791 S HENRY RD
RECEIVED_DATE
5/20/2003 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\H\HENRY\9791\PA-0300217\SU0003878\APPL.PDF \MIGRATIONS\H\HENRY\9791\PA-0300217\SU0003878\CDD OK.PDF \MIGRATIONS\H\HENRY\9791\PA-0300217\SU0003878\EH COND.PDF \MIGRATIONS\H\HENRY\9791\PA-0300217\SU0003878\EH PERM.PDF
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
59
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
_I <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> �1 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Camplew In TrbDealel <br /> APPLICATION 1.9 LURE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PEOXIIT TO CONSTRUCT ANDIOS INSTALL THE WOR(OFSCMRF.D.71119 AAgICATKIN IS MADE IN COMPLIANCE WOOD SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITU.CHAPTER <br /> 9 1115.3 AND THE STANDARDS OF BAN JOAQUIN CODU/N�TY�PUBLIC DFALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> AODRRSMR AAPNIF S/\�yO l.6 l\GI"LT` CITY \ •-Y<,Y�1t�„ qb <br /> OWNER'S NAME I V 'I` 1 YL- D h/Ci 1 �E PARCEL BIZEIAFNI Gl V <br /> ADORERS SA('h:`-' GQy- gC'gC <br /> CONTRACTOR-4917M G KO £T A YLD S S p/kI U � /�-3Y I 7 ATONE I <br /> A I 7 Q 6137 3�s 33Y y7z <br /> fiVB COMRACTOn V L—Oil-C.' \ AOODEpB <br /> LPC/ ATOO NE I <br /> TYPE OF WELURFMP:ANEW WELL ❑ HFFZACEMENT WELL ❑ MONRONND WELL I ❑ OTHER <br /> ❑ INITALLATK)N ❑ WELL SYSTEM REPAIR ❑ CncHM{omNECTRFPAIR ❑ VAFOR E%TMCiION WELL <br /> DYPE OF PUMA qN. L1 Rm � <br /> Nr N.P, l) DEPTH PUMP SET R. FIRST WATER L1VFL G <br /> ❑ OVT-0E-SERVICE WELL ❑ OEOAIYF.CAL WELL I ❑ 5011 BONITO <br /> IJDFBTRUCTIOH: VV[� <br /> INTENDED USF TYPEOF WELL CONSTRUCIIONWECIFICATIORS A <br /> 11 INDUSTRIAL ❑(OPENROROM DIA,OF WELL EXCAVATION PVC- MA <br /> CIA.OF CONDUCTOR CASING <br /> LIR � <br /> - COMESTMON � <br /> ' <br /> VATE jt1p0RAVEL PACK/SIZE TYPFOFCAANO/STEELT PVC- DIA.OF WELL CASINO O <br /> LJ PURLK:/MVNICtrAL Cl Ori DEPTH OF GROUT SEAL j')0 - SPECIFICATION J A <br /> 134—IRRIGATION/AG ❑OTHER GROUT SEAL INSTALLED BY-"" ❑I;JA//1L/.A GROW BRAND NAME (• --Fm c1 <br /> ❑ MOTORING GNWT SFAL PE <br /> AIMD ��gq <br /> yE_.r4- Ne CONCRETE PEDESTAL BY DNLLEn gy. [IN. S 'J� <br /> APPROX.DEPTHNI / V a LOCKING CHEATER BOX/STOVE APE S !� <br /> PROPOSED CONRTRIICTTONRRSLUNG METMO: MUD ROTARY x/1 AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY TI4AT I HAW PREPARED THIS APPK`ATK)N AND THAT THE WORK WILL BE DONE M ACCORDANCE WITH SAN JOA COUNTY ORDINANCES,STATE LAWO.AND R1RES AND(v <br /> REGULATIONS OF THE SAN"AWN COUNTY. HOME OWNEn OR VX NOFO AGENT'S SIGNATURE CFRTIAES THE FOLLOWING:'I CERTIFY THAT IN THE RRFOI0.IANCE OF THE WORK FDA WHICH l\ <br /> TMS PERMIT IN ISSUED.1 S11ALL NOT EM0.DY PERSONS SUBJECT TO WORKMAN'S COMHNe ATON LAWN OF CALIFORNIA,' CONTRACTOR'S HIM"OR OU"ONFMCTNG SIGNATURE CERTIFIER <br /> THE FOLLOWING: •1 CERTIFY THAT N THE PERFORMANCE OF THE WOR!FOR MOWN THIR PERMIT IO MOVED,1 SHALL EMMOY PERSON"SUBJECT TO WORKMAN'S COMFFNFADON LAWS OF <br /> CAUFORIIA' THE APgLCAA I MV/OT/C ALL N NOUFO IM ADVANCE FOR ALL REOUIIN IN N`OFC'T1RRM AT CONDO 4410 t 2f, COMPLETE DMYANG AT LOUDER ATEA PROVIDED. <br /> R,yr X A - �E �EJ,�_ Till. Q wF`�V „ <br /> PLOT FERN R),-1.%1.1 Oo.le le <br /> I. NAMES Or BTRETS OR ROADS NEARBT TO OR ROUNOIND THE FDOFERTY, e. LOCATION OF HOURE SEWAGE DISPOSAL RYSIEM on PROMISED <br /> ]. OVTIINE DF TNF AOPERTY,OIVNq DIMENBHONB AND NORTH D <br /> D O <br /> IRECTOR E%PANMON OF SEWAGE DISPDRAL eYBTEMR. <br /> 3, DIMENSIONED OUTLJNFO ANLOCATION OF ALL EXISTING A.PROMNS O E. LOCATION OF WELLS WITHIN MONS OF ONE DUMONT FIFTY R, <br /> STRUCTURE,IFICLUORM COVERS AREAS BUCII An PATHOS,DI IVEWAYO.AND WALKS. ON THE PROPERTY On ADJOn"M TROP TTY, <br /> J <br /> #ca,cvL� <br /> 1 <br /> MAY � <br /> LI <br /> rr.;. <br /> n ,7 DEPARTMENT USE ONLY <br /> Ai,.11-11 n A..IM RY 'lY ,/ <br /> Oieul lmProlbn BT O.1 /U�ms IneemGnn RY C.l. <br /> D1wv�ellen IwPrlbn V Dele <br /> CR.nn.o- <br /> ACCOUNTINO ONLY: AIDI PACI <br /> PE CODED FEE INTO lMT REMITTED, CACI( ADII RECEIVED BY OAT PERMIT/SM"CE REQUEST NUMBER INVOICE <br /> o a 30. o� y�q�I ;.� <br /> v v 0 0 -3/ .� <br /> Pub Health Sam.-Envlro.173(1/97) <br />
The URL can be used to link to this page
Your browser does not support the video tag.