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86-1597
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4200/4300 - Liquid Waste/Water Well Permits
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86-1597
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Entry Properties
Last modified
9/3/2019 10:08:16 PM
Creation date
12/2/2017 9:06:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
86-1597
STREET_NUMBER
29280
Direction
S
STREET_NAME
LEHMAN
STREET_TYPE
RD
City
TRACY
SITE_LOCATION
29280 S LEHMAN RD
RECEIVED_DATE
12/08/1986
P_LOCATION
MARK EDWARDS
Supplemental fields
FilePath
\MIGRATIONS\L\LEHMAN\29280\86-1597.PDF
QuestysFileName
86-1597
QuestysRecordID
1818277
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT' _ <br /> - SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` 1601 E. HAZELTON AVE., STOCKT_ON, CA <br /> Telephone 1209) 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 S Joaquin <br /> Local Health District. GO (r - � �L �Q� <br /> . O <br /> ' /��. PM <br /> Job Address 4 C' Lot Size <br /> Owner's Name Address <br /> 2 ! (/1L ' /�/!. / Phone <br /> Contractor ' Address &Lkense No. Phone <br /> TYPE OF WELL/PUMP: NEW WELL' WELL REPLACEMENT IJ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK — SEWER LINES DISPOSAL FLD.-A22–!;–(- PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA�CONSTRUCTION SPECIFICATION �� ' <br /> E3 Industrial EI Open Bottom LI Manteca Dia. of Well Excavation / ia. of Well Casing <br /> Domestic/Private Gravel Pack Tracy Type of Casing Specifications <br /> ❑ Public ❑ Other I ❑ Delta Depth of Grout Seal Type of Grout <br /> CK <br /> h ❑ Irrigation _Approx' Depth ❑ Eastern Surface Seal Installed by fy <br /> t <br /> Repair Work Done ❑ Type of Pump H.P. State Wo �one <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50'I U� <br /> Depth Filler Material (Below 50'1 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is <br /> available within 200 feet./ <br /> a <br /> Installation tion will serve: Residence— <br /> Commercial Other <br /> Number of living units: Number of bedrooms <br /> 4 Character of soil to a depth of 3 feat: Water table depth <br /> fI� SEPTIC TANK ❑ Type/Mfg CapacityNo. Compartments <br /> r PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation r Property Line <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line T <br /> SEEPAGE PITS ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ f __ <br /> I" 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 Carnia." <br /> The ap icon ust call for all qu' inspections. Compl a drawing vers ide. <br /> 1, Signed Title: Date: <br /> t _ R D ARTMENT SE QNLY <br /> s <br /> Application Accepted by Date v ���� Area <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> Additional Comments: I <br /> I ❑ 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 AMOUNT DUE AMOUNT REMITTED RECEIVED l3Y DATE PERMIT'NO. <br /> INFO <br /> + EH 19-24(REV.1/85) 76, . SSS „ Ck <br /> `" } Q/gb b-ti5°I7 ,. <br /> .EH,,1421k t�- <br />
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