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91-0591
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4200/4300 - Liquid Waste/Water Well Permits
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91-0591
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Entry Properties
Last modified
3/12/2020 12:01:01 PM
Creation date
12/2/2017 5:02:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
91-0591
STREET_NUMBER
305
Direction
S
STREET_NAME
HUTCHINS
City
LODI
SITE_LOCATION
305 S HUTCHINS
RECEIVED_DATE
03/08/1991
P_LOCATION
CITY THRIFT & LOAN
Supplemental fields
FilePath
\MIGRATIONS\H\HUTCHINS\305\91-0591.PDF
QuestysFileName
91-0591
QuestysRecordID
1759690
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT �1 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E, HAZELTON AVE. , PHONE (209)468-34@0 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> PERAIIT_ EXPURES 1 YEAR FROM DATE Issum APR r <br /> (Completer in Triplicate) <br /> NV I f i flt r-WC f >S �.T *his <br /> Application its hereby made,to San Joaquin County for a permit to construct and/or install tlR�.i► �1rj��xgip: d�'scr � e <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1$62 and the Rules etbfl Rleg{titS� of San <br /> Joaquin County Public Health Services. 9/ _,.[_ <br /> Job Address _s 6-- LtT-G T/� `s City Lot Size/Acreage // 0 Z� <br /> Owner's Name _f�� //T�lr�TL0�1V Address Fi V/1Phone <br /> /0 5t s- +� /S� <br /> Contractor i�W � �� G Address �P,9/1 0 /��-� d License lVv. 6 !'�j/ Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 0 DESTRUCTION „❑/Out of Service Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHERltpnitoring Well gofi JV 6-X <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> 0 Industrial 0 Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> Cl Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> i•1 Public 1-1 Other n Delta Depth of Grout Seal y e of Gr C k <br /> :- <br /> I I Irrigation =Appro_x, pepthi✓[ I Eastern Surface Seal Installed by <br /> Repair Work Done L3 Type of Pump H.P. State Work Done_ <br /> Well Destruction ❑ Well Diameter Sealing Material & Depth <br /> Depth Filler Material & Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIRIADDITION I I DESTRUCTION ( I INo septic system permitted it public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence, Commercial_ Other <br /> Number of living units: Number of bedrooms n <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. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE D No. & Length of lines Total length/size <br /> FILTER BED [_I Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS 11 Depth Size _ Number , <br /> -SUMPS — - - LI 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 County <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 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 erformance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion laws of Califo W' <br /> The applicant mu call f all required inspections. Co tete drawjpg on reverse side. / <br /> Signed X Title' t h4;-1,A- —„ ,. ✓Date: 3 <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date <br /> Pit or Grout Inspection by 4FDate Vinel Inspection by Date <br /> Additional Comments: <br /> Applicant Return all copies to: San Joaquin County Public Health <br /> Services, Environmental Health Permit/Services <br /> 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED CASHCK RECEIVED BY DATE rrrPERMIT'NO. <br /> + EH 24 1REV.riKsl <br /> CHA-29 <br /> i�-2e <br />
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