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91-0608
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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91-0608
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Last modified
3/12/2020 11:46:25 AM
Creation date
12/1/2017 1:49:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
91-0608
STREET_NUMBER
4105
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WY
City
STOCKTON
SITE_LOCATION
4105 N WILSON WY
RECEIVED_DATE
03/14/1991
P_LOCATION
BOB HUNEFELD
Supplemental fields
FilePath
\MIGRATIONS\W\WILSON\4105\91-0608.PDF
QuestysFileName
91-0608
QuestysRecordID
1987906
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> (209) 468-3447 <br /> PERMIT FJ R <br /> (Complete in Triplicate) <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in eenpli&nce with San Joaquin County Ordinance No. .549 and,1862 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. ] } <br /> ,G W 1 ity—� �Y� - Lot 31ze/Acreage � -.=-�--= ,7., <br /> Job Address <br /> ' t> Address Phone <br /> 7 3a <br /> -72 <br /> Owner's Name 7 r I <br /> 1. 5 Address �� CLicense No. 13 c� �''- Phone 3 r �! <br /> Contractor <br /> TYPE OF WELL/PUMP. NEW WELL D WELL REPLACE�FNT7DESTRUCTION ❑ Gut of Servide Well <br /> PUMP INSTALLATION C] SYSTEM REPAIR 0 <br /> 07}iER p Monitoring Well C7 <br /> I � _ DISPOSAL FLD. PROP, LINE <br /> DISTANCE TO NEAREST:'SEPTIC TANK SEWER LINES <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENOEQ_.U.SE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Dia. of Well Casing <br /> �M industrials- [3Open Bottom Cl Manteca Die. of Wall Excavation <br /> -•-` '� Type of Casing Specifications <br /> U Domasticl.Private` 0 Gravel Pack ❑ Tracy Type of Grout <br /> i M Public r 1-,1 Other ❑ Delta Depth of Grout Seal <br /> CJ Irrigation, Approx. Depth ❑ Eastern Surface Seal Installed by I <br /> Repair Wo►k Done U Type of Pump H.P. State Work Done <br /> gosling Material i Depth <br /> ;Weil Destruction © Well DiameterI. Piller Material i Depth <br /> Depth <br /> TYPE OF SEPTIC WORK: NEW 1NSTALLATiON REPAIRIAODITION Irl DESTRUCTION G (No septic system permitted if public sewer is <br /> 1 available within 200 feet.l <br /> Installation will serve: Residence__ Commercial__y__1Other- <br /> Number of fivinp unit$: -&— Number of bedrooms <br /> i Water table depth <br /> { Character of sail to a,depth of 3 feet: No. Compartments <br /> r• r� rt. 1 Capacity— <br /> .:--SEPTIC TANK. Type/Mfg F' <br /> Well F <br /> PKG. TREATMENT PLT. O/A , Method�ofD�isp�osa4 <br /> Distance to nearest: ; oundation PropartyL <br /> `Line iJi,.0-=t J <br /> -1,EACHING"L-INE__s: No. & Length of lines <br /> �• ' Total lengthlsize <br /> f.., Property Line <br /> FItTER sE0 r t n Distance to nearest: Well .x i F-o ndation <br /> k SEEPAGE PITS f Depth Sirs <br /> SUMPS p o� undation --- Property Line/�00 <br /> LI Distance to,nearesr. Well r""�'""` <br /> DISPOSAL-P.ONOS--•---•-fO— ~m <br /> I at the work will Iia done in accordance with San Joaquin county ordinances, state laws, and <br /> hereby certify that I have prepared this application and th <br /> rules and regulations of the San Joaquin County t '' <br /> +Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shoal not <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to wok r� pansa• <br /> tion law$of California." -, i �-, 3 }1 <br /> The applicant ust call for all requir In ctions.: bmptet�dr Ing on reverse side. - <br /> 1/ -Titie: a Detet <br /> E FOR DEPARTMENT USI_ ONLY <br /> Date ",� � Area 1 <br /> EApplication Accepted b F kl� -- - <br /> Dater t i Final Inspection by � �1V• {'' Date — <br /> Pit or Grout Inspection by <br /> r Additional Comments: <br /> +`R r <br /> Applicant - Return 511 Copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES <br /> 445 N SAN JOAQUIN, P O B 09, STOCKTON, CA 95201 <br /> FEE AMOUNT REMITTED C RECEIVED 8Y DATE PERMIVNO. <br /> AMOUNT DUE CASH <br /> I INFO <br /> . Eli •24 IREV.I i x i l ` �Aiti <br />
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