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88-2008
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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88-2008
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Last modified
12/2/2019 10:12:23 PM
Creation date
12/3/2017 2:58:09 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
88-2008
STREET_NUMBER
2419
STREET_NAME
MISTLETOE
City
STOCKTON
SITE_LOCATION
2419 MISTLETOE
RECEIVED_DATE
08/08/1988
P_LOCATION
DON MORROW
Supplemental fields
FilePath
\MIGRATIONS\M\MISTLETOE\2419\88-2008.PDF
QuestysRecordID
1854896
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> - SAN JOAQUIN LOCAL HEALTH DISTRICT A y� <br /> 1601 E. HAZELTON AVE., STOCKTON, CA' ti4W-a� <br /> `telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED NO. <br /> (Complete in Triplicate) application is <br /> 549 for sewage r No. 11362 for well!pump and the Rules and Regulations of the San Joaquin <br /> Application is hereby made to the San Joaquin Local Health No District for a permit to construct and/or install the work herein described.This <br /> made in compliance with San Joaquin County Or <br /> Local Health District, PM <br /> City Size <br /> [TYPE <br /> ob Address f <br /> r-�- d Phone <br /> Address <br /> ONEWELL ❑ <br /> owner's Name <br /> License1b.- —.--Rhone,_ <br /> Address ,. pESTRUCTION ❑ <br /> Contractor WELL REPLACEMENT ? - <br /> W ❑ <br /> OF WELL/PUMP: SYSTEM REPAIR D OTHER <br /> PUMP INSTALLATION DISPOSAL FLD. ' PROP. <br /> t SEWER LIN ES..r.�---�- PITS/SUMPS <br /> — <br /> DISTANCE TO NEAREST: SEPTIC TANK —�---AGRICULTURE WELL OTHER <br /> j FOUNDATION _.---- SPECIFICATIONS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONS pia. of Well Casing <br /> ❑ Open Bottom ❑ Manteca ia. of Well Excavation <br /> ❑ industrial Specifications <br /> cy TYpe of Casing _� : 11'4;-x,�.,._ <br /> ❑ Domestic/Private ❑ Gravel Pack - Type of Grout <br /> r ('1 Public <br /> 1711 Other <br /> t �! pelta Depth of Grout Seal � <br /> ' pr x. Depth l I Eastern Surface Seal Installed by <br /> I I Irrigation H P State Work Done — <br /> Repair Work Done Type of Pump <br /> k Well Destr ' n ❑ = <br /> Sealing Material (top 50'1 <br /> Well Diameter <br /> Depth Filler Material (Salow 501 No septic system permitted if public sewer is <br /> available within 200 feet.) y <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I7 REPAIRIADDlTIDN 1 I DESTRUCTION <br /> ICommercial Other <br /> l Installation will serve. Residence <br /> f Number of iiGing units: Nu tuber of bedrooms . Water_table depth <br /> f <br /> I Character of soil to a depth of 3 feet: Capacity No. Compartments <br /> { <br /> SEPTIC TANK ❑ Type/Mfg Method of Disposal <br /> PKG. TREATMENT PLT. fl Foundation Pro0erty.Line <br /> Distance to nearest: Well <br /> ITotal length/size <br /> LEACHING LINE ❑ No. &,Length of lines Foundation.�_�=.Property-Line <br /> FILTER BED ❑ DistanI ce to nearest: Well <br /> l <br /> $4Ze Number <br /> 1j <br /> SEEPAGE PITS I I Depth Property Line <br /> SUMPS ❑ Distance ce to nearest: Well Foundation <br /> DISPOSAL PONDS ❑ <br /> I <br /> I hereby certify that Y have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, an <br /> rules and regulations of the San Joaquin Local Health following: <br /> Home owner or licensed agent's signt. <br /> ature certifiesub ect Ito workman`srtcompensat on lawsoof shall not <br /> Californian"Contractor'swork for rhiringl or sub-contracting nt is lsignensa- <br /> employ any person in such manner as to become I <br /> !certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's campensa- <br /> certifies the following: " e <br /> tion laws of California." M <br /> The applicant must call for all required inspections. Complete drawing on reverse side. pQ� a <br /> I inn Date: V.. <br /> Title: <br /> Signed' <br /> p R DEPARTMENT USE ONLY <br /> E (,�+ _ Date� v Area <br /> Application Accepted by rte` Date <br /> Date Final Inspection by <br /> Pit or Grout inspection by <br /> Additional Comments: <br /> ❑ iti 46Com L7 Lodi'!kZ-3621 ❑ Manteca iov�kTracy 835- <br /> Additional Stk., CA 95201 <br /> Applicant Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, ` <br /> CK RECEIVED 9Y DATE PERMIT'ND. <br /> FEE OUNT DUE AMOUNT REMITTED CASH <br /> INF ��7 r <br /> +.EH 13-21(REV.I/H 51 +?r ���� <br /> EH 14-26 _... <br />
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