My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
87-2800
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
L
>
LIVE OAK
>
8422
>
4200/4300 - Liquid Waste/Water Well Permits
>
87-2800
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/13/2019 10:34:05 PM
Creation date
12/2/2017 10:06:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-2800
STREET_NUMBER
8422
Direction
E
STREET_NAME
LIVE OAK
City
LODI
SITE_LOCATION
8422 E LIVE OAK
RECEIVED_DATE
07/24/1987
P_LOCATION
DONELL LABOOTHE
Supplemental fields
FilePath
\MIGRATIONS\L\LIVE OAK\8422\87-2800.PDF
QuestysFileName
87-2800
QuestysRecordID
1824798
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
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 Co u ty 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 cak <br /> City Lot Size PM <br /> Owner's Name Ass Phone <br /> 1 �j' <br /> Contractor ddress icen e No. i Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL;REPLACEMENT ❑ DESTRUCTION <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <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 /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> f1 Public Cl Other n Delta Depth of Grout Seal Type of Grout - <br /> I I Irrigation —,Approx. Depth I i Eastern Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H,P. State Work Done _ <br /> Well Destruction ❑ Well Diameter Sealing Material ftop 50'1 <br /> Depth Filler Material (Belo 1 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 17 REPAIR/ADDITION I DESTRUCTION i 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: --I— Number of bedrooms �✓ <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 /> r <br /> LEACHING LINE ❑ No. & Length of lines T tal length/size <br /> FILTER BED ❑ Distance to nearest: Well/ a Foundation Property Line <br /> A. <br /> EPAGE PI l I Depth Size�� — Number <br /> SUMPS ❑ Distance to nearest: Well An In Foundation !J 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 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 ca all re ired in ion . Complet dr ingn"', <br /> e. <br /> Signed X Title: Date: 17 <br /> x FOR DEPART ENT USE ONLYIf <br /> Application Accepted by Date e Area <br /> Pit or Grout Inspection by Date 2—2 Final Inspection by DateZ�. <br /> Additional Comments: d <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant - Return ail copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE CK 4 <br /> INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED By DATE PERMIT NO. <br /> ♦ EH13-24IAEV.tiN51 -7 <br /> A.EH 1426 <br />
The URL can be used to link to this page
Your browser does not support the video tag.