My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
85-1533
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
N
>
99 (STATE ROUTE 99)
>
9521
>
4200/4300 - Liquid Waste/Water Well Permits
>
85-1533
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/19/2024 1:53:47 PM
Creation date
12/3/2017 5:25:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
85-1533
STREET_NUMBER
9521
Direction
N
STREET_NAME
STATE ROUTE 99
City
STOCKTON
SITE_LOCATION
9521 N HWY 99
RECEIVED_DATE
12/23/1985
P_LOCATION
GRUPE DEVELOPMENT
Supplemental fields
FilePath
\MIGRATIONS\N\99 (HWY99)\9521\85-1533.PDF
QuestysFileName
85-1533
QuestysRecordID
1878772
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
APPLICATION FOR PERMIT <br /> SAN JOAQUIN,LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON 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 <br /> Local Health District. No.549 for sewage or No. 1862 for"well/pump and the Rules and Regulations of the San Joaquin <br /> f " - <br /> - <br /> Job Address /�� <br /> ° " City Lot Size PM <br /> Owner's Name - Address T Phone <br /> Contractor Address <br /> 2-1 <br /> < <'� License No. 7 4ClG 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 2-7"""""AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE! TYPE OF WELL i PROBLEMIAREA CONSTRUCTION SPECIFICATIONS (n ` <br /> ❑ Industrial ❑ Open Bottom ❑;Manteca Dia. of Well Excavationv I <br /> Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack { El Tray ' Type of Casing <br /> ❑ Public t "Specifications <br /> ❑ Other a El Delta s. Depth of Grout Seal Type of Grout 1 <br /> ❑ Irrigation _A ; I <br /> pprox. Depth ❑"Eastem, Surface Seal Installed by <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done <br /> ru r i <br /> Well Destruction ❑ Well Diameter Sealing Material Itop 50'I <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAiR/ADDITION ❑ DESTRUCTION IN 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 ! I <br /> Character of soil to a depth of 3 feet: I s 1 I <br /> z , Water table depth 11 <br /> SEPTIC TANK ! ❑ Type/Mfg y�„ � l <br /> I. Capacity No. Compartments 1 1 <br /> PKG. TREATMENT 1PLT. ❑ I t <br /> Method of Disposalt <br /> 7-Distance to nearest:--�..-Well r• Foundation Property Line I <br /> M <br /> LEACHING LINE ❑ No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest:" Well Foundation Property Line <br /> .R <br /> SEEPAGE PITS ❑ Depth T Size <br /> Number <br /> SUMPS ❑ Distance to nearest: Well y Foundation Property,Line <br /> DISPOSAL PONDS ❑ i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin cou <br /> rules and regulations of the San Joaquin Local Health District. ' q t>tY ordinances, state laws, and <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. Contractor's.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 em !o <br /> tion laws of California." p Y persrins subject to,workman's compensa <br /> 3 } <br /> The applicant must call for a!I required inspections. Complete drawing on reverse side. <br /> Signed <br /> Title:' te s <br /> Date:. <br /> � I <br /> ` FOR DEP RTMENT USE ONLY <br /> Application Accepted by J��Z <br /> Pit or Grout inspection by Date Final Inspection by ,":z r <br /> ,bats- <br /> Ad tional Comments: r <br /> - �- ; .� <br /> tk 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, Sik., CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED CK <br /> INFO CA RECEIVED BY DgTE PEAMIT'NO. <br /> + EH 13-24 MEV.5YHal O� i �•�� ('�. • l --yam-, <br />
The URL can be used to link to this page
Your browser does not support the video tag.