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SR0081792
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4200/4300 - Liquid Waste/Water Well Permits
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SR0081792
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Last modified
3/16/2020 10:07:23 PM
Creation date
3/16/2020 2:10:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
FileName_PostFix
SSNL
RECORD_ID
SR0081792
PE
2603
FACILITY_NAME
CAIN PROPERTY
STREET_NUMBER
7555
Direction
S
STREET_NAME
COUNTRY
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
18514030
ENTERED_DATE
2/25/2020 12:00:00 AM
SITE_LOCATION
7555 S COUNTRY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
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Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE_ STOCKTON, CA 'PERMIT NO. <br /> Telephone (209) 466-6761 <br /> DATE ISSUED <br /> PERMIT EXPIRES 1 YEAR 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 <br /> described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump <br /> and the Rules and Regulations of the San Joaquin Local- Health District. <br /> Job Address_� p ..r 1 i Subdivision Name <br /> Owner's Name I" Address Phone s <br /> Contractor's Name oc3r'�2+TC> L ' License No.` S�f�T��' �" Phone <br /> r <br /> ?: -TYPE OF WELL/PUMP WORK: NEW WELL WELL REPLACEMENT DESTRUCTION Cf <br /> PUMP INSTALLATION SYSTEM REPAIR OTHER Q <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE j <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIOtS <br /> _ 1-1 Industrial tc Q Open Bottom E]Manteca Dia. of Well Excavation i <br /> L_IDomestic/Private Gravel Pack Tracy'' Dia. of Well Casing ' <br /> Public Other []Delta Type of Casing F <br /> (J Irrigation- Approx. Eastern fit• <br /> f Cathodic•Protection Depth . <br /> �; t !~ Specifications, <br /> Geophysical;•. , y Oepth;bf Grout Seal f <br /> t Type of Grout ' <br /> Other ' SJr*face Seal Installed by <br /> Repair Work Done Type of Pump H.P. t State�Work Done ~� <br /> Well Destruction F-1 Well Diameter Sealing Material (top 50 1) x _ <br /> Depth Filler Material (Bel ow 50,)tLU <br /> l <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION IV REPAIR/ADDITION u' (No septic-tank or seepage pit permitted if public sewer is <br /> t ► available within 200 feet.) <br /> Installation will serve: Residence Commercial . Other,. <br /> } Number of living units: _ Number of bedrooms f-3, `�Lotlsize ,�. <br /> Character of soil to a depth of 3 feet: I % • - Water table depth <br /> SEPTIC TANK Type/Mfg la ' Capes acity z INo. Compartments <br /> PKG. TREATMENT PLT. Type/Mfg Capacity Method of Disposal <br /> i SEWAGE SYSTEM Distance to nearest: Well foundatign -lam Property Line `s <br /> 1} DESTRUCTION ❑ .. 1• . ,. '+. '. a <br /> } LEACHING LINE No. '& Length,of lines. ^ L/ Total length/size,• ? <br /> FILTER BED Zistance-to'nearest:4 Well :Foundation Property Line., <br /> f SEEPAGE PITS Depth _ 916*' Size.— Number <br /> SUMPS L_J-.-Distance to.nearest: Well /r-T;&ndation 6'y4' Property Line 0292 4' <br /> DISPOSAL PONOS. (].. '" ` V , <br /> I•hefidti rtify that I have`iprepared this application and that the work will bedoneiri accordance with San Joaquin county <br /> ordinances, state laws, and rules and regulationsofthe San Joaquin.l.4cal health"Dis`trict. - <br /> Home Owner or licensed agent;s signature certifies-the.foliowing: "I certify that,in the perforMance of the work-for which this <br /> permit is issued, I shall not.employ any person inNucb:'rt nrier�as to become subject to workmant compensation laws of California." <br /> Contractor's hiring or sub-contracting signature certifies the foll.ow)ng: ":'I certify that in the performance of the work for which <br /> 4 this permit is issued. I shall employ persons subject to workman's co6px2nsation laws of California." <br /> fThe applicant must call fo all required inspections. .Complete drawing on reverse side. <br /> Signed % /��yyiG "V '" ..,, Title: -.-.. Date:. <br /> ' OR D TM U NLY <br /> Application Accepted b Area Stk 466-6781 <br /> Additional Comments: 369-3621 <br /> Pit or Grout Inspection -- A :-� <br /> f ate 6 Manteca 823-7104 <br /> Final Inspection by ' Date Q P.O*Tracy 835-6385 a <br /> Applicant -Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave:', . Box 2009, Stk., CA 'x95201 <br /> -- -FEE, -8ASE_—AMOSIN.T,DUE--. :�31-AMGUNT-REMITTED- --RECE,IAO--BY---- - DATE• ,-- PERMIT NO.- <br /> INFO, <br /> O.-INFO' �'- <br /> wI-S 1_ <br /> EH 13-24 REV. 10/82 ` f0/82,500 `+ <br /> 14-26 :i. .. <br />
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