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90-393
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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90-393
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Last modified
3/4/2020 11:13:47 PM
Creation date
12/3/2017 12:51:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
93-393
STREET_NUMBER
3000
Direction
W
STREET_NAME
MARCH
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
3000 W MARCH LN
RECEIVED_DATE
02/23/1990
P_LOCATION
GRUPE DEVELOPMENT
Supplemental fields
FilePath
\MIGRATIONS\M\MARCH\3000\90-393.PDF
QuestysFileName
90-393
QuestysRecordID
1841828
QuestysRecordType
12
Tags
EHD - Public
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e i <br /> APPLICATION FOR PERMIT 1 <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 City Stkh Lot Size+1 00 PM <br /> Owner's Name Grupe Development Address 2291 W March Phone i <br /> Contractor Clark Well Address 2 -'Y' License No. 371 5-6_Q—Phone_ - <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTIONS <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP, LINE 2 r <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 /> FI Public ❑ Other , 1 11 Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation _..Approx. Depth I I Eastern Surface Seal Installed by - <br /> rState Work Done _ <br /> Repair.-Work Done ❑ Type of Pump H.P. <br /> Well Destruction ❑r Well Diameter F rr Sealing Material Itop 501) <br /> Depth Filler Material (Below 50'1 <br /> TYPE. OF SEPTIC WORK: NEW INSTALLATION i.1 REPAIR/ADDITION i I DESTRUCTION I I INo septic system permitted it public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence J Commercial_ Other r <br /> Number of living units: —_ Number of bedrooms <br /> Character of soil to a depth of 3 feet-1 Water table depth <br /> SEPTIC TANK ❑ Type/Mfg/_ _ Capacity No. Compartments <br /> PKG, TREATMENT PLT. ❑ Method of Disposal <br /> r Distance to nearest: Well Foundation 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 I Depth - Size _ Number- <br /> III SUMPS L] 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 compensation laws of California."Contractor's hiring or sub-contracting signature <br /> certifies the following:"I tha -n the perform ce of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion laws of Cala rn I <br /> I The applicaryt' s c or all r qui ins tion Complete drawing on reverse side. <br />{ Signed X-` r Title: "VP Clark Well Inc Data: 23 Feb 90 <br /> r _ <br /> yz #.t F DEPARTMENT USE ONLY Y f <br /> q -7 - 1 Area <br /> � ,� <br /> Application Accepted by Date <br /> Pit or Grout Inspection by Date Final Inspection Date <br /> t <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 AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO. <br /> INFO CA <br /> + EH 1324(REV.1/851 VS <br /> EH 14-28 <br />
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