My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
74-351
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
L
>
LAWRENCE
>
16600
>
4200/4300 - Liquid Waste/Water Well Permits
>
74-351
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
4/12/2019 10:04:14 PM
Creation date
12/2/2017 8:57:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
74-351
STREET_NUMBER
16600
STREET_NAME
LAWRENCE
STREET_TYPE
RD
SITE_LOCATION
16600 LAWRENCE RD
RECEIVED_DATE
07/23/1974
P_LOCATION
KEN DOTSON
Supplemental fields
FilePath
\MIGRATIONS\L\LAWRENCE\16600\74-351.PDF
QuestysFileName
74-351
QuestysRecordID
1817381
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
SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> FOK OFFICE USE: 1601 E. Hazelton Ave. Stockton, Calif. <br /> Telephone: (209) 466-6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. 3 s-/gyp <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued <br /> (Complete In Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> end/or install the work herein described. This application is made in compliance with San Joaquin <br /> County Ordinance Na. 1862 and the Rules anda ulatf ns of the San Joaquin Local Health District. <br /> JOB ADDRESS/LOCATION r I �� �� ,00"e <br /> `.4-, s <br /> / CFNSCT <br /> Owner's Name �. flew 1Zc?s�C O S l � <br /> Phone <br /> Address <br /> City <br /> Contractor's Name License #,-- Phone <br /> TYPE OF WORK (Check): NEW WELL /? DEEPEN -/? RECONDITIO - - -7 DESTRUCTION /_7 Y ` <br /> PUMP INSTALLATION / / PUMP REPAIR / / PUMP REPLACEMENT <br /> Other /% <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES. PIT PRIVY <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OAR <br /> PROPERTY LINE - PRIVATE DOMESTIC WELL PUBLIC DOMESTIC � <br /> TYPE OF WEWELL <br /> INTENDED USE LL CONSTRUCTION SPECIFICATIONSWELL <br /> Industrial Cable Tool Dia. of Well Excavation <br /> Domestic/Domestic/private Drilled Dia. of Well Casing <br /> Irrigation <br /> Driven Gauge of Casing <br /> Irxigation Gravel Pack_ Depth of Grout Seal <br /> Cathodic Protection Rotary Type of Grout' - <br /> Disposal Other Other Information <br /> Geophysical Surface Seal Installed B <br /> PUMP INSTALLATION: Contractor <br /> Type of Pump H.P. <br /> PUMP REPLACEMENT: / / State Work Done <br /> PUMP :REPAIR: Y / State Work Done- - <br /> ES•TRUCTIONN OF WELL: Well Diameter <br /> D 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. I WILL CALL FOR A GROUT INSPECTION <br /> PRIOR TO GROUTING D A N NSPECTION. <br /> SIGNED <br /> TITLE <br /> (DRAW PLOT PLAN ON REVERSE SIDE <br /> PHASE I FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY DATE <br /> 1712 <br /> ADDITIONAL CONMENTS V--`�6 , <br /> PHASE II GROUT INSPECTION '� _r�+ PHA FINAL INSPECTION <br /> INSPECTION BY DATE INSPECTION BY <br /> DATE J <br /> E H 1426 - Rev. 1-74 <br />�. _ _ 1-74 2M <br />
The URL can be used to link to this page
Your browser does not support the video tag.