My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
85-1428
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
M
>
MORADA
>
4816
>
4200/4300 - Liquid Waste/Water Well Permits
>
85-1428
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/23/2019 10:39:43 AM
Creation date
12/3/2017 3:16:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
85-1428
STREET_NUMBER
4816
STREET_NAME
MORADA
STREET_TYPE
LN
City
STOCKTON
SITE_LOCATION
4816 MORADA LN
RECEIVED_DATE
11/14/1985
P_LOCATION
DELLA DEVELOPMENT
Supplemental fields
FilePath
\MIGRATIONS\M\MORADA\4816\85-1428.PDF
QuestysFileName
85-1428
QuestysRecordID
1856689
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
} <br /> APPLICATION FOR PERMIT <br /> SAN JOAO.UIN 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. 1662 for well/pump and the Rules and Regulations of the San Joaquin <br /> Local Health District. <br /> .4816 Morada Lane Stockton 334' X 174f MS 84-1 <br /> Job Address City Lot Size PM <br /> Owners Name Delit- Denelopment Address p0 box 7414 Phone 931-0343 4, <br /> Contractor's Name Clark Well License No. 371560 Phone 2$X-462-767 <br /> TYPE OF WELL/PUMP: NEW WELL 9 WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION $1 SYSTEM REPAIR ❑ f5vp 151 t <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. u PROP, LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS -� <br /> ❑ Industrial Q Open Bottom ❑ Manteca Dia. of Well Excavation tf Dia. of Well Casing 6 5/811 ten,, <br /> 91 Domestic/Private 91 Gravel Pack ❑ Tracy Type of Casing_ Steel Specifications # 12 115�, <br /> ❑ Public ❑ Other ❑ Delta Depth of Grout Seal 51), Type of Grout 9 Sack <br /> ❑ Irrigation --Approx. Depth ❑ Eastern Surface Seal Installed by Clark <br /> Repair Work Done ❑ Type of Pump S LI b H.P. 3 hp State Work Done install <br /> Well Destruction ❑ Well Diameter Sealing Material Itop 501 J <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is I <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 /> c , <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS ❑ Depth Size Number <br /> SUMPS ❑ Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS ❑ <br /> 1 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 suc as to becoe Nect to workman's compensation laws of California."Contractor's hiring or sub-contracting signature <br /> certifies the following:" a ify th in or nce of the work for which thi it. issued,I shall employ persons subject to workman's compensa- <br /> tion laws of Califor is s <br /> The applican It f 11 r quire pect' ns. omplete drawing on a side. <br /> Signed X Title- Date: <br /> l'V <br /> Ji <br /> FOR E MENT USE ONLY <br /> Application Accepted by Date ' rea <br /> Pit or Grout Inspection by Y Date �� �� Final Inspection by Date <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 6355-6385 <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 DATE PERMWNO. <br /> + EH 1324(REV.10/83) �YZ� <br /> EH 1428 l�� <br />
The URL can be used to link to this page
Your browser does not support the video tag.