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90-1347
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4200/4300 - Liquid Waste/Water Well Permits
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90-1347
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Last modified
1/21/2020 10:12:01 PM
Creation date
12/2/2017 8:46:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-1347
STREET_NUMBER
3243
Direction
E
STREET_NAME
LATHROP
STREET_TYPE
RD
City
LATHROP
Zip
95330
SITE_LOCATION
3243 E LATHROP RD
RECEIVED_DATE
04/26/1990
P_LOCATION
GEORGE SILVA
Supplemental fields
FilePath
\MIGRATIONS\L\LATHROP\3243\90-1347.PDF
QuestysFileName
90-1347
QuestysRecordID
1815503
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T ON 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 /> h ,v� <br /> +°�� �.�,��.,,(( � j I g J D <br /> Job Address.3A4J E c�tl.���n-{114 t"��C City �t Size <br /> 3� PM <br /> Jt� <br /> Owner's Name �4trtnt� Address Phone <br /> Contractor T/ .d�� _-_Addressrg tt� <br /> ��A6 � 4 �3License NAO}g-y_Phone r �� <br /> TYPE OF WELL/PUMP: NEW WELL ❑ ,—WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR jiG 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 ❑ Manteca Dia.'of Well Excavation Dia. of Well Casing <br /> Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> 11 Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout _ <br /> I I Irrigation _,Approx. Depth: I I Eastern � Sutface Seal Installed by <br /> Repair Work Done $_ Type of Pump H.P. _ State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material {top 501 _ KEito <br /> Depth Filler Material (Below 50') — f , <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION (1 REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is W <br /> available within 200 feet.) <br /> Installation will serve: Residence — Commercial— Other y <br /> Number of living units: Number of bedrooms <br /> t W <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 ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to.nearest: Well Foundation Property Line <br /> SEEPAGE PITS 'I. I Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line l <br /> DISPOSAL PONDS ❑ r" <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 /> 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 must cal for all requi�r d inspections. Complete drawing on reverse side. <br /> Signed X Title: GL1.— Date: <br /> *' y <br /> � -FOR DEPARTMENT.USE ONLY <br /> Application Accepted by '€ w Date �Ur Area <br /> Pit or Grout Inspection by Date I� Final Inspection Data <br /> `F <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 523-7104 l ❑ Tracy 635-6385 <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEEI CKI <br /> INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE EPERMIT'NO. <br /> +.EH 13-241NEV.i 5) 3�-Go EH 14-26 <br /> :e <br />
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