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89-2955
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4200/4300 - Liquid Waste/Water Well Permits
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89-2955
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Entry Properties
Last modified
1/6/2020 10:18:12 PM
Creation date
12/1/2017 1:17:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
89-2955
STREET_NUMBER
3150
Direction
N
STREET_NAME
WILCOX
STREET_TYPE
RD
City
STOCKTON
SITE_LOCATION
3150 N WILCOX RD
RECEIVED_DATE
12/8/89
P_LOCATION
ALLEN ASKEW
Supplemental fields
FilePath
\MIGRATIONS\W\WILCOX\3150\89-2955.PDF
QuestysFileName
89-2955
QuestysRecordID
1985530
QuestysRecordType
12
Tags
EHD - Public
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r f <br /> APPLICATION FOR PERMITr� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> C'4" �� �� 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES TYEAR 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. <br /> LJob Address City 2 Lot Size PM <br /> Owner's Name Address Phone d i <br /> Contr Address License No Phone <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL RE ACEMENT ❑ DESTRUCTION ❑ t, I <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 /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Manteca Iia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> I'i Public F1 Other Ll Delta Depth of Grout Seal Type of Grout <br /> I I Irrigation --Approx. Depth I I Eastern Surface Seal Installed by - <br /> Repair Work Done D Type of Pump H.P. , State Work Done <br /> Well Destruction , © Well Diameter Sealing Material Itop 50'1 Q <br /> Depth Filler Material (Below 501 <br /> TYPE OF SEPTIC'WORK: NEW INSTALLATIO REPAIRIADDITION € I DESTRUCTION I I (No septic system permitted if public sewer is <br /> available within 200 feet.I i <br /> Installation will serve: Residence— Commercials Other <br /> i <br /> Number of living units: Number of bedrqpmq_ <br /> Character'of soil to a depth of 3 feet: Water table depth ^- <br /> SEPTIC TANK ❑ Type/Mfg Capacit I&X No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE No. & Length of lines Total length/size <br /> FILTER-BED ❑ Distance to nearest: --Well Foundation Property Line <br /> SEEPAGE PITS I I Depth Size Number_ <br /> SUMPS ❑ .Distance to nearest: Well Foundation Property Line <br /> 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: "1 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 applicant m call f all re Complete drawing on reverse side. <br /> 144 <br /> Signed X 1 Title: � � - Date: <br /> ENT USE ONLY <br /> Application Acceptedby Date Area <br /> Pit or Grout Inspection by Date Final Inspection by !� Data <br /> Additional Comments: <br /> ❑ Stk 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, Stk.' CA 95201'. <br /> f IFEE NFO AMOUNT DUE AMOUNT REMITTED CASCK H RECEIVED BY DATE PERMIT'NO. <br /> + EH13-24(REV.tik5) —70 .o – <br /> EH 14-28 <br />
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