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93-482
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4200/4300 - Liquid Waste/Water Well Permits
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93-482
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Last modified
6/11/2020 10:07:42 PM
Creation date
12/2/2017 5:09:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
93-482
STREET_NUMBER
575
STREET_NAME
INDUSTRIAL
STREET_TYPE
DR
City
MANTECA
SITE_LOCATION
575 INDUSTRIAL DR
RECEIVED_DATE
03/24/1993
P_LOCATION
SCHWANS SALES ENTER
Supplemental fields
FilePath
\MIGRATIONS\I\INDUSTRIAL\575\93-482.PDF
QuestysFileName
93-482
QuestysRecordID
1781284
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION <br /> SAN JOAQUIN COUNTY PUBLIC <br /> HEALTSISERVICES <br /> ENVIRONMENTAL PHONE (209)468-ON 3420 <br /> 445 N SAN JOAQUIN, CA 95201 <br /> P O BOX 2009, STOCKTON, <br /> 1 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUID <br /> �a4" leteLGft-x- in Triplicate) <br /> win County fora permit to construct and/or install the work herein Regdesulations of San <br /> 6 <br /> Application is hereby Made,to San Joa9 L and r in and the Rules and Aegula <br /> Bance with San Joaquin County Ordinance No. 5 9 / <br /> Joaquin Con is made in comp F�� S �L m, <br /> Joaquin County Public Health Service rJ <br /> ity Lot Size/Acreage <br /> '~mob Address .-rq Phone <br /> }5 (dress VPho <br /> r'1 [ �Nwner's Name fe " <br /> License No. <br /> est DESTRUCTION ❑ put of rvice well (-1 <br /> contractor WELL REPLAC / tlf ing well cl <br /> V NEW WELL O OTHER ZI50p � t �� <br /> TYPE OF WELL PUMP: SYSTEM REPAIR C <br /> PUMP INSTALLATION ❑ DISPOSAL fLD. PROP. LINE <br /> SEWER LINES ----- p17SISUMPS <br /> DISTANCE TO NEAREST: SEPTIC TANK --r--�— AGRICULTURE WELL OTHER WELL <br /> FOUNgATION �------�— <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIOjJS Dia. of Well Casing <br /> O Open Bottom ❑ Manteca Dia. of Well Excavation c <br /> CJ Industrial Specifications "l <br /> L7 Tracy Type of Casing— <br /> [I Domestic/Private ❑ Gravel Pack al Type of Grout <br /> (-I Other [-1 Delta Depth of Grout Se <br /> I'4 Public Surface Seal installed by * � <br /> I I Irrigation —Approx Depth l I Eastern State Work Done <br /> Repair Work Done L7 Type of Pump Sealing Material A Depth <br /> Well Destruction O Well Diameter A <br /> r Filler Material i Depth <br /> Depth permit ad it public sewer is <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIRIADDI7IQN i f DESTRUCTION I I ONailabletrwithin 200 feet.) <br /> fr�� <br /> V� <br /> installation will serve: Residence— <br /> Commercial — Ot#ser -- <br /> Number of bedrooms Water table depth <br /> Number of living units: i _ <br /> Character of soil to a depth of 3 feet: No. Compartments <br /> ❑ Type/Mf CaPacity�----- <br /> SEPTIC TANK MlMethod of Disposal <br /> PKG. TREATMENT PLT, ' Foundation Property Line <br /> Distance to nearest: Well <br /> �� Total length/size <br /> LEACHING LINE CI No. & Length of tines <br /> FILTER BED Cl Distance to nearest: Well Foundation ___—�— Property Line <br /> ��---- <br /> Number <br /> SEEPAGE PITS 11 Depth f Size Well <br /> Line _ --- <br /> R Foundation <br /> SUMPS LI Distance to nearest: Well �.-- <br /> DISPOSAL PONDS C7 <br /> I hereby certify that l have prepared this application end that the work will be done in accordance with San Joaquin county ordinances, state laws, and <br /> l not <br /> rules and regulations of the San Joaquin County following: work lot <br /> Home owner or licensed agent's signature certifies Th ecto workman's so on lawsoof California,"hContractor's thui g or sub-contractinghis permit is ssignd I <br /> become <br /> (� <br /> employ any person in such manner as to become 1 ` <br /> certifies the following:"I certify that in the performance of the work for which this permit is issued, I shall employ per subject to workman's compensa� <br /> tion laws of C iforrtla." <br /> The applicant u cal for all uired inspections. Complete drawing on reverse side. <br /> Title: Date: <br /> Signed <br /> FOR DE AR ENT USE ONLY <br /> L4� t7 f r Q <br /> Date Area <br /> Application Accepted by Date Final Inspection Dat <br /> Pit or Grout Inspection by <br /> �-- - <br /> Additional Comments; <br /> Applicant - Return all copies to: Bnvironmentaloaquin oHealth unty uPermit/Servicesblic Health viees <br /> 445 N San Joaquin, P O Sox 2009, Stkn, CA 95201 <br /> CK RECEIVED DATE PERMIT N0. <br /> l AMOUNT DUE AMOUNT.REMITTED r <br /> S <br /> INFO ;l <br /> � - <br /> . Ex13-2A IRtN.I I <br /> EH 11'411—1 ay 7 <br />
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