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72-281
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LOUISE
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4200/4300 - Liquid Waste/Water Well Permits
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72-281
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Entry Properties
Last modified
3/5/2019 2:56:41 AM
Creation date
12/2/2017 10:49:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-281
STREET_NUMBER
1277
Direction
E
STREET_NAME
LOUISE
City
LATHROP
SITE_LOCATION
1277 E LOUISE
RECEIVED_DATE
4/14/1972
P_LOCATION
NINERVA NICHOLS
Supplemental fields
FilePath
\MIGRATIONS\L\LOUISE\1277\72-281.PDF
QuestysFileName
72-281
QuestysRecordID
1831427
QuestysRecordType
12
Tags
EHD - Public
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FOIL OFFICE USE: APPLICATION FOR WELL OR PUMP PERMIT PERMIT NO. <br /> (Complete in Triplicate) Date Issued: �v <br /> HIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> i <br /> APPLICATION IS HEREBY MADE TO THE SAN .JOAQUIN LOCAL HEALTH DISTRICT FOR A PERMIT TO PERFORM <br /> THE WORK STATED HEREON. THIS APPLICATION IS MADE IN COMPLIANCE WITH COUNTY ORDINANCE <br /> NO. 1862 AND RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> JOB ADDRESS/LOCATION: rJ CENSUS TRACT: <br /> OWNER'S NAME: a PHONE: <br /> ADDRESS: P� CITY: <br /> CONTRACTOR'S NAME: EN At LICENSE # PHONE: <br /> INTENDED USE: INDIVIDUAL DOMESTIC WATER WELL f ---PUBLIC WATER WELL / / TEST WELL <br /> IRRIGATION/LIVESTOCK./AGRICULTURAL-WATER WELLINDUSTRIAL WATER WELL <br /> / / JJ <br /> CATHODIC PROTECTION WELL / GEOPHYSICAL WELL /_/ OTHER <br /> NEW WELL: DISTANCE TO NEAREST: .SEPTIC TANK SEWER LINES �PIT PRIVY ~ <br /> SEWAGE DISPOSAL FIELDS('( CESSPOOL SEEPAGE PIT OTHER <br /> REPAIRS: TYPE OF REPAIRS; <br /> .J <br /> ABANDONMENT/DESTRUCTION: METHOD TO BE USED: <br /> PLOT PLAN: SHOW ON REVERSE -SIDE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK'WILLIBE DONE IN <br /> ACCORDANCE WITH THE PROVISIONS OF THE LAWS OF THE STATE OF CALIFORNIA, THE ORDINANCES OF THE <br /> COUNTY OF SAN JOAQUIN, AND THE RUE AND REGU TI OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> SIGNED: x CONTRACTOR: <br /> PHASE I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY: �� CJ --^�_` DATE: <br /> ADDITIONAL COMMENTS: ' ' -' <br /> PHASE II PAASE III FINAL <br /> INSPECTION BY:� �� DATE ^��3 7� INSPECTION BY: D ` o� ' <br /> E H 1426 SAN JOA UIN LOCAL HEALTH DISTRICT 1/72 1M <br /> DISTRIBUTION; WHITE-HEALTH DISTRICT - YELLOW-PROPERTY OWNER - FINK-CONTRACT <br />
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