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88-492
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MCKINLEY
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4200/4300 - Liquid Waste/Water Well Permits
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88-492
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Last modified
12/14/2019 10:09:54 PM
Creation date
12/3/2017 1:58:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-492
STREET_NUMBER
10710
STREET_NAME
MCKINLEY
STREET_TYPE
AVE
City
FRENCH CAMP
SITE_LOCATION
10710 MCKINLEY AVE
RECEIVED_DATE
03/08/1988
P_LOCATION
MR SULLIVAN
Supplemental fields
FilePath
\MIGRATIONS\M\MCKINLEY\10710\88-492.PDF
QuestysFileName
88-492
QuestysRecordID
1848113
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> �N SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 'f'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. I! <br /> w <br /> Job Address City Lot Size PM <br /> Owner's Name Address C Phone <br /> ;i <br /> Contractor� � _Address_(� 7r/C `�a 4•i License NJ �U73 Phone <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 /> *{ _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing <br /> Li Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing 3 Specifications <br /> ('l Public -1 Other Cl Delta Depth of Grout Seal _ Type of Grout _ <br /> I Irrigation :.:Approxi"De h" -I-I-Eastern'—Sirtface Seal Installed by <br /> Repair-Work Done 4T_ Type of Pump H.P. I State Work Done <br /> s <br /> Well Destruction ❑ Well Diameter Sealing Mateltial (top 501 <br /> � <br /> DepI th Filler Material_ (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION (I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is <br /> II available within 200 feet.) <br /> Installation will serve: Residence— Commercial_ Other Y, <br /> i a <br /> Number of living units: Number of bedrooms <br /> ,� <br /> Character of soil to a depth�of 3 feet: _ 1 Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity r-No. Compartments r <br /> PKG. TREATMENT PLT. ❑ .�. ,, Method of Disposal <br /> Distance to nearest: Well Foundation ri Property Line <br /> LEACHING LINE ❑ :No- & Length of lines .Total length/size <br /> :a- <br /> FILTER BED ❑ (Distance to nearest: Well 'Foundation Property Line <br /> SEEPAGE PITS l 1 `Depth _ Size �4�' i Number <br /> _ SUMPS ❑ !6stance to nearest: Weil +Foundation Property Line <br /> - <br /> I. a,. � -ii'� 11_._-_ - r, -may; - -•: - ..- _ - �i. - <br /> DISPOSAL PONDS 0 it f '"` �'� '�" ` <br /> I hereby certify that I have prepared this a_pplication,and that 11he.work will be done in accordance with San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin Local Health Districts <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'bbmpensation laws of California." Contractor's hiring or sub-contracting-signawre <br /> certifies the following: "i certify that in the performance of the work for which this permit is issued, 1 shall employ persons subject to workman's compensa- <br /> tion laws of California." II a j <br /> The applica ust II for all)re uired inspections.'Complate..drawing o reverse side. <br /> Signed X Title: Date: �� <br /> �! FOR IVPARTMENT USE ONLY <br /> Application Accepted by Date 3 Area <br /> I Pit or Grout Inspection by :N Date Final Inspection by ��//' Date <br /> Additional Comments: �N <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 623-7104 ❑ Tracy 835-6385 <br />' Applicant- Return all copies to: Environmental Health PefmitlServices 1601 E. .Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> li <br /> FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT-NO. <br /> INFO CASH <br /> �I <br /> EH 13-241REV.I/Nsf - <br /> EH 14-2e <br /> 1. II <br />
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