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89-1970
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WATSON
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217
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4200/4300 - Liquid Waste/Water Well Permits
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89-1970
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Last modified
12/26/2019 10:10:23 PM
Creation date
12/1/2017 12:18:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-1970
STREET_NUMBER
217
STREET_NAME
WATSON
STREET_TYPE
AVE
City
MANTECA
SITE_LOCATION
217 WATSON AVE
RECEIVED_DATE
7/27/1989
P_LOCATION
LAWRENCE SANCHEZ
Supplemental fields
FilePath
\MIGRATIONS\W\WATSON\217\89-1970.PDF
QuestysFileName
89-1970
QuestysRecordID
1995118
QuestysRecordType
12
Tags
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 t GL _ City / Lot Size PM <br /> Owner's Nam Address f f l/[/. Q�.. alt— Phone <br /> Contractor-li�l Q� �-e.Lc/ Address 12,7-11VAL ao&ilk( �t,d,�. License No.��� 32.(a Phone Zr —1 <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER G�_ <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 ❑ Open Bottom ❑ Manteca Dia. of,Well Excavation Dia. of Well Casing <br /> 9L Domestic/Private ?❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> i'l Public ❑ Other F Delta Depth of Grout Seal Type of Grout <br /> I I irrigation r,t _Approx. Depth I 1 Eastern Surface Seal Installed by D <br /> Repair Work Done rp- Type of Pump �r�Y H.P.I State Work Done ® v <br /> Well Destruction ❑ Well Diameter Sealing Material {top 501 \ S <br /> 54 /JjiW466,ZZ ,Depth* 012- Filler Material (Below 50') �{ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION l I DESTRUCTION t I (No 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 bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity LL No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well roundation 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 1 Depth Size Number <br /> SUMPS - ❑ Distance to nearest: Well Foundation Property Line <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 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 compgnsation 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 s cC31L all required inspections. Complete drawing on reverse side. <br /> Signed X Title: Date: 12-7 EPARTMENT USE ONLY <br /> Application Accepted by Date Area <br /> Pit or Grout Inspection by Date Final Inspection by,,Cg,, 5A Date <br /> Additional Comments: <br /> ❑ 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 <br /> INFO AMOUNT DUE AMOUNT REMITTED K H RECEIVED BY DATE PERMIT-NO. <br /> . EH 1324 fREv,r h sl ! �� �J <br /> EH 11-2e / <br />
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