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90-2420
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RINDGE
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4200/4300 - Liquid Waste/Water Well Permits
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90-2420
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Last modified
2/23/2020 12:50:51 AM
Creation date
12/1/2017 6:53:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
90-2420
STREET_NUMBER
8177
Direction
W
STREET_NAME
RINDGE
STREET_TYPE
RD
City
STOCKTON
APN
07105026
SITE_LOCATION
8177 W RINDGE RD
RECEIVED_DATE
09/12/1990
P_LOCATION
SACRAMENTO CELLULAR
Supplemental fields
FilePath
\MIGRATIONS\R\RINDGE\8177\90-2420.PDF
QuestysFileName
90-2420
QuestysRecordID
1908382
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT } - <br /> ' SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ( t� ENVIRONMENTAL HEALTH DIVISION <br /> `f 1601 E. HAZELTON AVE. , PHONE (209)468-3420 <br /> P O BOR 2009, STOCKTON, CA 95201 <br /> PT"IT EXPIRES 1 YEAR FROM LATE ISSUED <br /> .1�?�V✓' .. .� , (Complete its Triplicate) <br /> Application is hereby made to Saw �Joaq C unty for a permit to construct and/or install the work herein described. This <br /> application is made in compliance withSanJoaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin CoPUWC Health Services. <br /> -* , ,, NOCz <br /> Job Address APw 0:11 - 001�4I L;ta bin Ur tkaae City Lot Size/Acreage <br /> 5 WGra rv�p v�- p C�ll�Lt,r- <br /> Mo dt4 r la_•.f we.,l sc-w �e 3 a o <br /> Owner's Name Te-I f 01064 C�om�4dn J__ Address s4-c r.-A Z Phone <br /> Contractor -� Address ZSZS"C. A�tr'�k _ License No. S t Z,7-V g Phone to S�$Z E Z <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION CI Out of Service well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER �y7p� / nitoringWell <br /> C7 <br /> / �7pr4�4�F�1.CKK <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> I- so, p_, <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS 11 <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS l <br /> C Industrial ❑ Open Bottom ❑ Manteca Dia. of JNe" Excavation (.�` Dia. of Well Casing <br /> 5 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> 1'1 Public 1.1 Other ❑ Delta Depth of Grout Seal `-��� Type of Grout r�1__M <br /> i I Irrigation —Approx. Depth I I Eastern Surface Seal Installed by <br /> Repair Work Done L] Type of Pump H.P, State Work Done_ <br /> Well Destruction ❑ Well Diameter Sealing Material & Depth <br /> Depth Filler Material & Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION f I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if ptiblic sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial_ Other <br /> Number of living units: Number of bedrooms <br /> FN <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK. 0 Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to near I <br /> est' Well Foundation Property Line <br /> F r <br /> LEACHING LINE L1 No. & Length of lines Total length/size a <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property Line <br /> SEEPAGE PITS 11 Depth Size Number <br /> SUMPS LI 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 County <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 worts for which this permit is issued, I shall employ persons subject to workman's compansa- <br /> tion laws of Califo " <br /> The applicant ust II for all required to C mplete drawing on reverse side. <br /> Signed y Title: _ Date: <br /> 10 <br /> F D ARTMENT USE ONLY 'moi <br /> Application Accepted by Date Area - <br /> wzzy <br /> Pit or Grout inspection by Date Final Inspection by Date L (tom <br /> Additional Comments: <br /> i <br /> Applicant - Return all copies to: San Joaquin County Public health <br /> Services, Xnvironmental Health Permit/Services <br /> 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 <br /> FEEi <br /> AMOUNT DUE AMOUNT REMITTED RECEIVED 8V DATE PERMIT N0. <br /> INFO XUA <br /> ^� <br /> + EH13.24(REV.1/As) <br /> EH 114-25 G7 1 "�-�r.� �i` O n' 1,aA <br /> i <br />
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