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87-4176
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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87-4176
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Entry Properties
Last modified
11/23/2019 10:06:08 PM
Creation date
12/1/2017 11:27:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-4176
STREET_NUMBER
346
Direction
S
STREET_NAME
WALKER
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
346 S WALKER LN
RECEIVED_DATE
11/20/1987
P_LOCATION
GERRY FORD
Supplemental fields
FilePath
\MIGRATIONS\W\WALKER\346\87-4176.PDF
QuestysFileName
87-4176
QuestysRecordID
1973820
QuestysRecordType
12
Tags
EHD - Public
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a APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T ON AVE., STOCKTON, CA 0\AJ /OAA� <br /> I Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1YEAR FROM DATE ISSUED ')Z) <br /> (Complete in Triplicate) 1 A <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 Joaquin 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. <br /> Job Address 3 k'e City S "SVS2 Lot Size 5 V /t V5d n PM <br /> Owner's Name i'r Eor q Address 5%U f9 r y:)e Q <br /> Phone <br /> Contractor Address License No.397Sy-j I Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLAC ENT ❑ _ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTE EPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK WER LINES DISPOSAL FLD. - PROP. LINE <br /> FOUNDATION AG ULTURE ELL OTHER WELL PITS/SUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA ONS7RUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type Casing Specifications <br /> F1 Public ❑ Other ❑ Delta Depth of ut Seal Type of Grout <br /> ! I Irrigation —___Approx. Depth i I Eastern Surface Seal In Iled by <br /> Repair Work Done ❑ -Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth 1 Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIR/ADDITION l-1 DESTRUCTIO (No 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 S <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 /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> � p <br /> SEEPAGE PITS 11 Depth Size Number ' <br /> SUMPS ❑ Distance to nearest: Well Foundation 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 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 tobecome 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 shalt employ persons subject to workman's compensa- <br /> tion laws of California." 1 <br /> The applican ust call for all required '+spections. Complete drawing on reverse side. <br /> Signed X Title: d W YU_P_ Y1 t a� C) <br /> Date: <br /> N�o tF DEPARTMENT USE ONLY <br /> Application Accepted by <br /> a <br /> Date 'd^U Area <br /> Pit or Grout Inspection by Date Final Inspection by Date <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 95201 <br /> 1 k <br /> FEE <br /> INFO AMOUNT DUE i AMOUNT REMITTED K RECEIVED BY DATE PERMIT NO. <br /> J�j CASH pp <br /> + EH 13-24(REV.$/Nsf �"� ___1 <br /> EH 14-26 r /yI <br />
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