My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
90-1659
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
G
>
GARNICA
>
1511
>
4200/4300 - Liquid Waste/Water Well Permits
>
90-1659
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
2/2/2020 10:44:14 PM
Creation date
12/2/2017 12:29:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-1659
STREET_NUMBER
1511
Direction
N
STREET_NAME
GARNICA
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
1511 N GARNICA AVE
RECEIVED_DATE
06/23/1990
P_LOCATION
MIKE TAPP
Supplemental fields
FilePath
\MIGRATIONS\G\GARNICA\1511\90-1659.PDF
QuestysFileName
90-1659
QuestysRecordID
1783282
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
APPLICATION FOR PERMIT <br /> 7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT p <br /> 1601 E:'HAZES i ON. AVE., STOCKTON, CA <br /> Telephone 12091"466-6781 <br /> F <br /> PERMIT EXPIRES TYEAR 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'iJoaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. I <br /> Job Address -57 Chit Size PM <br /> Owner's Name �F._� [_-t Address +(�fv-7"(� /��G�. �� Phone , <br /> Contracto�az— vV, Address +?(Dosox License No. Z 3 Phone 4-66 16 <br /> TYPE OF WELL/PUMP: : I NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ t <br /> PUMP INSTALLATION SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST:' SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> h <br /> FOUNDATION AGRICULTURE WELL OTHER WELL— PITSISUMPS <br /> � - l <br /> INTENDED USE # TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Ind trial O Open Bottom El Manteca Dia. of Well Excavation Dia. of Well Casing •` <br /> j <br /> omestic/Private i❑ Gravel Pack ❑ Tracy Type of 'Casing Specifications <br /> 1-1 Public IF1Other Cl Delta Depth of Grout..Seal` Type of GroutJr <br /> '+ y <br /> I I Irrigation s _ApF& Depth �J 1-E' stern Surface Sea`installed by' <br /> Repair Work Done IBS Type of Pump 1k-"H-.P1- State Work Done 604 Ldl Al <br /> Wel! Destruction ❑ Well Diameter Sealing Material (top 50') _ 1 <br /> Depth Filler Materia! {Below 50') <br /> f ' -- <br /> TYPE OF SEPTIC WORK: ": NEW INSTALLATION 11 REPAIR/ADDITION l I DESTRUCTION l I INo septic system permitted if public sewer 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: 1<�� 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 /> k <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ ' Distance to nearest: Well Foundation Z Property Line <br /> ! <br /> V-7 <br /> SEEPAGE PITS I'] : Depth Size • Number <br /> SUMPS ' y}' ❑ Distance to nearest: Well Foundation y Property Line <br /> DISPOSAL PONDS ❑ `� <br /> I hereby certify that I have'prepared this application and that the work will be done in accordance with San Joaquin county ordinahces, state laws, and <br /> rules and regulations of the San Joaquin Local Health DoMfict. dV <br /> Homeowner o i ensed a is signature ce les the foil g: "1 certify that in the performance of the work for which this permit is issued, I shall not <br /> employ any arson in such m ner as to be a subje to rkman's compensation laws of California."Contractor's hiring or sub-contracting signature <br /> certifies t following: ' pertif that in th a of a work for which this ermit is issued, I shall employ persons subject to workman's compensa- <br /> tion lawof California." 1 j <br /> The app cant mu or req d Co drawing on side. s 1 a� <br /> Signed X Titfe: '� Date: /( - ye- <br /> � '1 <br /> R DEPARTMENT USE ONLY t <br /> Application Accepted by I 7 Aare , Date Area <br /> Pit or Grout Inspection by Date Final Inspection by!�_7' . Data <br /> --"'Additional-Comments: -- -v---- <br /> ❑ Sik-,466-6781 j\-0-Lodi 369-3621 ❑ Manteca 523-7104 0 Tracy eW5-6385 *�, <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton`Ave'.,'P.O.Box 2009, Stk., CA 95201 <br /> 6 <br /> INFOEE OU�--NT DUE AMOUNT REMITt GASH RECEIVED BY DATES PERMIT-NO. I <br /> ♦.EH 13-21(REV.1/H51 irte' <br /> EH 14-26 {J V - <br /> .h- <br /> 'a <br />
The URL can be used to link to this page
Your browser does not support the video tag.