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87-3179
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4200/4300 - Liquid Waste/Water Well Permits
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87-3179
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Last modified
11/15/2019 10:08:13 PM
Creation date
12/2/2017 2:42:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-3179
STREET_NUMBER
0
STREET_NAME
PADDY CREEK
RECEIVED_DATE
8/27/1987
P_LOCATION
SAN JOAQUIN COUNTY
Supplemental fields
FilePath
\MIGRATIONS\H\HARNEY\0\87-3179.PDF
QuestysFileName
87-3179
QuestysRecordID
1745683
QuestysRecordType
12
Tags
EHD - Public
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1f Z' 3 U <br /> z � APPLICATION FOR PERMIT <br /> ( SAN JOAQUIN LOCAL HEALTH DISTRICT SCONED <br /> 1601 E. HAZELiON AVE., STOCKTON, CA <br /> li Telephone (209) 466-6781 <br /> i` PERMIT EXPIRES VYEAR FROM DATE ISSUED <br /> Ii (Complete in Triplicate) <br /> I <br /> Application is he+eby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described.This application is t <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 /> �liryory r � z /z/`9i e Lot Size Cac.� J.+�/GtJ PM <br /> Job AddressQ��`y��cy�f — — City <br /> p ,� II 4 ptry Address�a Q '51e �'�d/1 Phone 24V'V-42 e1 <br /> Owner's Name _ - -�, / <br /> Ii 11 S.3fo GG/dam 5 fah $T, f. <br /> S7 <br /> E 9Jly S Phon <br /> License No. <br /> Contractor �4� /' S!/� h/S Address -1 �Sgepa� <br /> TYPE OF WELL/PUMP: I NEW WELL)Q�-%011INWELL REPLACEMENT LJ DESTRUCTION <br /> PUMP INSTALLATION 171t SYSTEM REPAIR-0 OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK + SEWER LINES DISPOSAL FLD. PROP. LINE <br /> li <br /> y0 i/mics c�i rn FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL j PROBLEM AREA CONSTRUCTIOWSPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom 4 © Manteca Dia. of Well Excavation 3__16 Dia. of Well Casing <br /> r T e of Casin I Specifications <br /> ❑ Domestic/Private ❑ Gravel Pack . -❑ Tracy 4 yp g «. <br /> i Public ��f.,O�i(Sher n ❑ Delta Depth of Grout Seal �./ �- Type of Grout <br />` I I Irrigation W�pprox. Depth i, K Eastern Surface Seal Installed by - <br /> Repair Work Done ❑ Type of Pump a H.P- State Work Done <br /> p { -R[: C. 'Grow <br /> Well Destruction ❑ Well Diameter` '�_ Sealing Material (top 50'1 r* <br /> i Fot Kc1*:'►o.& TWesilb"Vepth it i Filler Material (Below 50'j <br /> 15EPTIC WORK: NEW INSTALLATION I ] ?REPAIR/ADDITION i.l pESTRUCTION l l (No septic system permitted if public sewer is <br /> TYPE OF <br /> 4; -•-a- ;' available within 200 feet.) <br /> Installation will serve: Residence Commercial t Other__->. <br /> Number of living units: l� Number of bedrooms ' <br /> Character'of soil to a depthi!of 3 feet: ' Water table depth <br /> SEPTIC TANK ❑ I}Type/Mfg t � Capacity No. Compartments ' <br />` PKG. TREATMENT PLT- ❑ i�� 11 Method of Disposal <br /> N hbistance to nearest: Y ell Foundation <br /> ) Property Line <br /> LEACHING LINE ❑ IIINo. &^Length of lines t Total tehgth/size <br /> FILTER BED ❑ 1,Distance to-rlearest. Well 1, °`Foundation Property Line <br /> II <br /> t <br /> SEEPAGE PITS ( I .10opth Size Number <br /> SUMPS ❑ ll Distance to nearest: Well -Foundation Property Line r- * -• <br /> DISPOSAL PONDS ❑ ;� ) <br /> i 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. f i r + <br /> k 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 /> Ik employ any person in such manner as to become 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 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applican t all for all re urred ins ctions. Complete drawing:on reverse side. <br /> Signed t Title: kSaC/GTS Grd�� - i*r�rDate: <br /> IIy DEPART NT USE ONLY <br /> I ; Date V Area <br /> Application Accepted by <br /> F r r Dat <br /> Pit or Grout Inspection by Date Final Inspection by <br /> �07 <br /> V4 �. <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 �.❑ Manteca.: 821,7104 Cl Tracy-1;835-6385 <br /> I Applicant - Return all copies'to: Environmental'Health Permit/Services 1601-E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> I FEE AMOUNT DUE AMOUNT'REMITTED CK RECEIVED BY DATE PERMIT NO. <br /> INFO <br /> II Q2 <br /> + EH 13-241REV.i/n51 <br /> EH 14-26 t <br /> ( li. <br />
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