My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
86-589
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
U
>
UNION
>
13577
>
4200/4300 - Liquid Waste/Water Well Permits
>
86-589
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/7/2019 10:20:58 PM
Creation date
12/1/2017 9:51:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
86-589
STREET_NUMBER
13577
Direction
S
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
APN
20410005
SITE_LOCATION
13577 S UNION RD
RECEIVED_DATE
06/06/1986
P_LOCATION
P G FRY PROPERTIES
Supplemental fields
FilePath
\MIGRATIONS\U\UNION\13577\86-589.PDF
QuestysFileName
86-589
QuestysRecordID
1963281
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
r h <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ! z, (Complete in Triplicate? c(— <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. TMs application is <br /> „made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules nd Regulations of the San Joaquin <br /> Local Health-District. <br /> -city .LCL <br /> oil Addressc� ,C Size <br /> Ownee's Name N• Address / ��' u I,�L NI LotdA&AZ Phone 23 — s <br /> I <br /> Contractor Address S No._.Z7���� Phone <br /> TYPE OF WELL/PUMP: NEW WELL X WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION� /0SYSTEM REPAIR El OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK /00 14 SEWER LINES DISPOSAL FLD./W ' PROP. LINE <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 I1 Dia. of Well Casing <br /> Domestic/Private )W Gravel Pack ❑ Tracy Type of Casing Specifications rr_ <br /> 11 Public El Other ❑ Delta Depth of Grout Seal Type of Grout ✓! <br /> ❑ Irrigation --Approx. Depth ❑ 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 6 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is 5 <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 ry <br /> PKG. TREATMENT PLT. ❑ Method of Disposal G <br /> Distance to nearest: Well Foundation Property Line O <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 n <br /> f� 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 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 applica st call for all r uire nspections Co:TTitl <br /> in reverse side. <br /> Signed Date;" r . <br /> tiz. <br /> OR DEPARTMENT USE ONLY <br /> a <br /> Application Accepted by Date ,� �� '� r <br /> Pit or Grout Inspection by - Date Final Inspection b "'�"" Date <br /> Additional Comments: srKl iYi <br /> ❑ Stk 4664781 ❑ 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 AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT-NO. <br /> INFO C <br /> + EH 13-24(REV.1/951 <br /> EH 14-28 "�� <br />
The URL can be used to link to this page
Your browser does not support the video tag.