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88-2167
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4200/4300 - Liquid Waste/Water Well Permits
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88-2167
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Last modified
12/4/2019 10:13:58 PM
Creation date
12/2/2017 8:13:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2167
STREET_NUMBER
805
STREET_NAME
KRISTEN
STREET_TYPE
CT
SITE_LOCATION
805 KRISTEN CT
RECEIVED_DATE
08/22/1988
P_LOCATION
TED KATZAKIAN
Supplemental fields
FilePath
\MIGRATIONS\K\KRISTEN\805\88-2167.PDF
QuestysFileName
88-2167
QuestysRecordID
1812110
QuestysRecordType
12
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EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <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 described. This application is <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 /> Job Address cit;Z-4, Lot Size PM <br /> Owner's Na Address Phone <br /> Contrac `I Address,4,"_ _Z�Zen?'l icense No� 2.2 6 Phona� J !06 <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER CJ <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 /> ❑ Industrial 0 Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack. ❑ Tracy Type of Casing Specifications — <br /> f` Public FI Other Cl Delta Depth of Grout Seal Type of Grout <br /> t I Irrigation —.Approx. Depth l I Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.-P. ' "-State Work Done <br /> Well Destruction 0 Well Diameter Sealing Material (top 50'1 <br /> Depth 'ter Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I] RFPAI ADDITION DESTRUCTION I 1 INo septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial Other <br /> Number of living units: _/_ Number of b Brooms <br /> Character of soil to a depth of 3 feet: Water table depth (1 <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. 0 s - Method of Disposal <br /> Distance to nearest: _Well- Foundation Property Line <br /> LEACHING LINE >1/ No. & Length of lines Z T— Total length/size <br /> FILTER BED ❑ Distance to nearest: Well. Foundation Property Line N:5-- <br /> SEEPAGE PITS 11 Depth f� —Size p� Number <br /> SUMPS >< Distance to nearest` Well 160' Foundation 10 Property Line .S <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 Local Health Di%trict. <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 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 applicant m t call f re fired inspections. Complete drawing on reversed side <br /> Signed X Title: V. Date <br /> FOR EPARTMENT USE ONLY g <br /> Applicati Accepted by� f _ Date Area <br /> 'Pit ut-ffispect+Eon by ate-- V_';;'!P1Final inspection by <br /> Additional Comments: <br /> LI Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE �/ PERM`IIT'NO./] <br /> +.EH13-24WEV.t/H51 ! Oi Q4'7 ��y �p <br /> EH 14-29 ���.��^^^ ���ffifff r <br /> 4 _ � <br />
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