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88-1578
EnvironmentalHealth
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MARIPOSA
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4200/4300 - Liquid Waste/Water Well Permits
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88-1578
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Last modified
11/30/2019 10:09:38 PM
Creation date
12/3/2017 1:17:02 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-1578
STREET_NUMBER
2501
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
2501 E MARIPOSA RD
RECEIVED_DATE
06/24/1988
P_LOCATION
BJJ TRUCKING
Supplemental fields
FilePath
\MIGRATIONS\M\MARIPOSA\2501\88-1578.PDF
QuestysFileName
88-1578
QuestysRecordID
1844473
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCALHEALTH DISTRICT / <br /> !/ <br /> 1601 E. HAZE I ON 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 /> v <br /> Job Address �06z` City Lot Size PM <br /> Owner's Name o �� t r�Q CC)JA Address Phone <br /> Contractor dressez- icense No. hone I <br /> TYPE OF WELL/PUMP: NEW VIUL ❑ WELL REPLACEIVEW ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ _ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE�-- <br /> FOUNDATION <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-Casinq <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> ('1 Public 71 Other, 1-1 Delta Depth of Grout Seal Type of Grout r� <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 (top 50') <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION l I REPAIR/ADDITION i I DESTRUCTION I 1 (No septic system permitted if public sewer is <br /> available within 200 feet.) n� <br /> Installation will serve: Residence_& Commercial Other ^ Y� <br /> Number of living units: —2=— 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. �I45)( <br /> ISY � &716 KMethod of Disposal <br /> Distance to noeaaarest`_Well Foundation Property Line <br /> 46W S)R <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line 7 <br /> SEEPAGE PITS I I Depth Size Number <br /> SUMPS Ll 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 Di§trict. <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 subj ect.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 =ficantmu 11for all required i tons. C lo_te drawin n reverse side. r� <br /> Sign4a X— itle: Date: "` <br /> FOR DEPARTMENT USE ONLY l <br /> Application Accepted by Date r " Area a <br /> Pit or Grout Inspection by Date Final Inspection by - K A- Date �r <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 CASH RECEIVED BY `gyp DATE PERMIT'NO. <br /> EH 13-24 1 REV.I/n a) <br /> EH 14-29 J 4 p <br />
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