My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
77-119
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
L
>
LAKE
>
882
>
4200/4300 - Liquid Waste/Water Well Permits
>
77-119
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/18/2019 10:33:44 PM
Creation date
12/2/2017 8:21:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
77-119
STREET_NUMBER
882
Direction
E
STREET_NAME
LAKE
STREET_TYPE
STREET
SITE_LOCATION
882 E LAKE STREET
RECEIVED_DATE
2/15/1977
P_LOCATION
WAYNE STODDARD
Supplemental fields
FilePath
\MIGRATIONS\L\LAKE\882\77-119.PDF
QuestysFileName
77-119
QuestysRecordID
1813157
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
AA 2'17 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> �'Ot. "OFFICE USE: 1601 E. Hazelton Ave. , Stockton, Calif <br /> Telephone: (209) 466-6781 4 / <br /> { APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No7-119 <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ate Issued �?' <br /> (Complete In Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. - This application is made in compliance with San Joaquin <br /> County Ordinance No. 1862 and the, Rules and Regulations of the San Joaquin Local Health District. <br /> JOB ADDRESS/LOCATION Z. <br /> �8 CENSUS TRACT <br /> Owner's Name �4Phone <br /> Address 9 J'j. It I%— l P City <br /> kkaxr <br /> Contractor's Name Licensehonq23-Ay-1 L <br /> TYPE OF WORK (Check) : NEW WELL IM DEEPEN '/_/ RECONDITION / / DESTRUCTION /-7 <br /> PUMP INSTALLATION 4�/ PUMP REPAIR / / PUMP REPLACEMENT /- <br /> Other 1-7 <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY <br /> r <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER h <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS <br /> Industrial Cable Tool Dia. of Well Excavation <br /> =Domestic/private =Drilled Dia. of Well Casing <br /> - -- <br /> Domestic/public Driven Gauge of Casing <br /> Irrigation Gravel. Pack Depth of Grout Seal <br /> Other 'Rotary Type of Grout <br /> Other Other Information; <br /> i <br /> t <br />' PUMP INSTALLATION: Contractor <br /> Type of Pump H.P. <br /> PUMP REPLACEMENT: / / State Work Done <br /> PUMP 'tEPAIR: / / State Work Done <br />' DFgTRUCTION OF WELL: Well Diameter . Approximate Depth <br /> Describe Material and Procedure <br /> I hereby agree to comply with all laws and regulations of the San Joaquin Local Health District <br /> and the State of California pertaining to or regulating well-construction. Within FIFTEEN DAYS <br /> after completion of my work on a new well, I will furnish the San Joaquin Local Health District a <br /> WELL DRILLERS REPORT of the well and notify them before putting the well in use. The above <br /> information is true to the best of my knowledge and belief. ` <br /> SIGNED TITLE <br /> (DRAW PLOT PLAN ON REVERSE SIDE) <br /> FOR DEPARTMENT USE ONLY <br /> fi PHASE I <br /> APPLICATION ACCEPTED BY DATE P--J?-71 <br /> ADDITIONAL COyMENTS: <br /> PHASE II GROUT INSPECTION PHASE III/FINAL INSPEPTIV <br /> INSPECTION BY DATE -/ - INSPECTION BY DATE Ste -- 2 <br /> E �- -D <br /> AHL1FOR 42 6 A GROU INSP],C ION <br /> PRIOR o� GROUTING AND FINAL NSP��O � w t,J�� 7�im <br /> fi <br />
The URL can be used to link to this page
Your browser does not support the video tag.