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88-375
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4200/4300 - Liquid Waste/Water Well Permits
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88-375
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Entry Properties
Last modified
12/12/2019 11:03:56 PM
Creation date
12/3/2017 1:48:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-375
STREET_NUMBER
2357
STREET_NAME
MCCOMB
City
STOCKTON
SITE_LOCATION
2357 MCCOMB
RECEIVED_DATE
2/24/88
P_LOCATION
HARRY BICKFORD
Supplemental fields
FilePath
\MIGRATIONS\M\MCCOMB\2357\88-375.PDF
QuestysFileName
88-375
QuestysRecordID
1847827
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T 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 /> Y�Joh Address _ G- / A� `^� `' City J rQC,�`E+ Lot Size PM <br /> (0_ner's Name r"S Address Phone <br /> `Contractor Ce L._ Address ,# "� License No. Phone ASC 3—I—C'o <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 r� <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing l /1 <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> E'1 Public ❑ Other fl Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation --Approx. Depth I 1 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 501 n <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION l 1 REPAIR/ADDITION f I DESTRUCTION (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: 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 /> 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 /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> 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." Contractors 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 call for all required inspections. Complete drawing on reverse side. J <br /> Signed XTitle: Date: �.�'-Z <br /> OR DEPARTMENT USE ONLY <br /> Application Accepted by f Date 2--may X Area <br /> Pit or Grout Inspection by / Date /� Final Inspection by Date 3 2 <br /> Additional Comments: �-//rJ_ 76—120 <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 /> INFO AMOUNT DUE AMOUNT REMFEEITTED CK RECEIVED BY DATE PERMIT No. <br /> r EH 13-241R <br /> EV. /nsl <br /> EH 14-2e ' <br />
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