My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
72-70
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
L
>
LUCILE
>
2022
>
4200/4300 - Liquid Waste/Water Well Permits
>
72-70
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/24/2019 10:05:40 PM
Creation date
12/2/2017 11:36:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
72-70
STREET_NUMBER
2022
STREET_NAME
LUCILE
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
2022 LUCILE AVE
RECEIVED_DATE
10/5/1972
P_LOCATION
BILL DELGADO
Supplemental fields
FilePath
\MIGRATIONS\L\LUCILE\2022\72-70.PDF
QuestysFileName
72-70
QuestysRecordID
1835261
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 /> FOR OFFICE USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> v U A/ Telephone: {209} 465-67$1 <br /> \ICATION FOR WELL CONSTRUCTION: OR PUMP PERMIT Permit No. <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 /> and/or install the work herein described. This application is made in compliance with San Joaquin <br /> County Ordinance No. 1$62 and the Rules and Regulations of the San Joaquin Local Health District. <br /> srx N <br /> JOB ADDRESS/LOCATION ) Gly . V CENSUS TRACT <br /> Owner's Name /L L �,C O Phone <br /> Address [\ z-P C-P LZ City <br /> Contractor's Name License 11/,:Q h.'hone <br /> TYPE OF WORK (Check): NEW WELL Aq DEEPEN / / RECONDITION /7 DESTRUCTION /-7 <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 OTHER }� <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS l <br /> industrial Cable Tool Dia. of Well Excavation <br /> Domestic/private -- Drilled Dia. of Well Casing <br /> Domestic/public Driven Gauge of Casing _ SjDaI-1 <br /> Irrigation Gravel Pack Depth of Grout Seal �� amD <br /> Other Rotary Type of Grout /! RMI <br /> Other Other Information I-L <br /> PUMP INSTALLATION: Contractor G f-= b4C C" <br /> Type of Pump t1Mt- • H.P. <br /> PUMP REPLACEMENT: . /-7 State Work Done , �� <br /> PUMP REPAIR: / / State Work Done <br /> .DESTRUCTION OF WELL: Well Diameter 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. <br /> 5 <br /> SIGNED TITLE <br /> DRAW PLOT PLAN ON REVERSE SIDE) <br /> FOR DEP64TIAENT USE ONLY <br /> PRASE I _ <br /> APPLICATION ACCF U.n BY DATE <br /> ADDITIONAL COMMENTS: <br /> PHASE II GROUT INSPECTION PHASE, III/FINAJ, INSPECTION <br /> INSPECTION BY DATE INSPECTION BY -O SAT <br /> CALL FOR A GROUT INSPECTION PRIOR TO GROUTING AND FINAL INSPECTION. <br /> F E H 1426 4/72 1M <br />
The URL can be used to link to this page
Your browser does not support the video tag.