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88-3249
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HARRISON
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4200/4300 - Liquid Waste/Water Well Permits
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88-3249
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Last modified
12/11/2019 11:19:36 PM
Creation date
12/2/2017 3:12:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-3249
STREET_NUMBER
2430
Direction
S
STREET_NAME
HARRISON
City
STOCKTON
SITE_LOCATION
2430 S HARRISON
RECEIVED_DATE
12/09/1988
P_LOCATION
CITY OF STOCKTON REHAB
Supplemental fields
FilePath
\MIGRATIONS\H\HARRISON\2430\88-3249.PDF
QuestysFileName
88-3249
QuestysRecordID
1747358
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE.; STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED a <br /> E (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 Joaquin County Ordinance No.549 for sewage or No. 1B62 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. I . <br /> Job Address City I <br />{ ! /0 Lot Size PM <br /> � 5e' <br /> Owner's Name`/ Address Phone <br /> Contractor t `C Address 7 C-1 f"+ F ArL cerise No <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL. OTHER WELL PITS/SUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom C1 Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ <br /> Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> 1-1 Public ❑ Other ❑ Delta Depth of Grout'Seal Type of Grout <br /> i l Irrigation _..Approx. Depth I ) Eastern - Surface Seal Installed by - <br /> r <br /> y Repair Work Done ❑ Type of Pump H.P. State Work Done r <br /> Well Destruction ❑ Well Diameter Sealing Material (top 501 <br /> Depth F Filler Material Welow <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION €=1 REPAIR/ADDITION I DE$TRUCTiON 1No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> 1 Installation will serve: Residence_ Commercial Other <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT.D I Method of Disposal <br /> Distance sto nearest: Well Foundation Prooerty Line <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well' Foundatiori Property Line <br /> SEEPAGE PITS l I Depth t Size Number <br /> $ SUMPS ❑ Distance to nearest: Well . Foundation Property Line <br /> DISPOSAL PONDS ID <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 /> i 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 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 /> I The applican st cavfof��a 'n ctions. Complete drawing on erse side. J <br /> Signed X Title: 4 Date: <br /> k FOR DEPARTMENT USE ONLY <br /> Application Accepted by //-/ Date Area ZV? <br /> Pit or Grout Inspection by Date Final Inspection by 4 �-^� Dater <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 I <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE AMOUNT DUET AMOUNT REMITTED K RECEIVED BY DATE PERMIT NO. <br /> INFO <br /> ♦.EH 13-24{REV.r/K 51 t: I cit I <br /> .aicrr g$31+iq <br /> EN 14-28 1 <br />
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