Laserfiche WebLink
i <br /> SAN JOAQUIrt; LOCAIL HEALTH DISTRICT <br /> FOR OFFICE USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephonef (209) 466-67$1 <br /> PLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. L <br /> THIS PERMIT EXPIRES1 YEAR FROM DATE 'ISSUED , Date Issued. <br /> i (Complete In 'Triplicate) <br /> Application is.hereby made to the San Joaquin 'Local health District for a permit to construct <br /> and/or install the work herein described. This application is made in compliance with San Joaquin <br /> County Ordinance No. 1562 and the Rules and Regulations of the San Joaquin Local Health District. <br /> + JOB ADDRESS/LOCATION 8236 E. Rairchild Rd. CENSUS TRACT <br /> Owner's NamePrieto 6574.. Phone <br /> Address' . Fairchild Rd.. City Stockton <br /> Contractor's Name j er 0. Noack & Son Inc. License # 200794 Phone 466- 1695 <br /> TYPE OF WORK (Check) : NEW WELL/ / DEEPEN '/ / RECONDITION /_� DESTRUCTION <br /> PUMP INSTALLATION 0/ PUMP REPAIR / / PUMP REPLACEMENT /? <br /> Other <br /> oq <br />' DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS .-�►� <br /> Industrial Cable Tool Dia. of Well Excavation <br /> Domestic/private Drilled Dia. of Well Casing <br /> Domestic/public Driven Gauge of Casing <br /> Irrigation Gravel Pack Depth of Grout Seal <br /> Other Rotary Type of Grout <br /> Other Other Information <br /> PUMP INSTALLATION: Contractor Walter S. Noack & Siin <br /> t <br /> Type of Pum 3 YP P 304L8 S�ttr. . <br />� PUMP REPLACEMENT. / X/ State Work Done _VV. <br /> I / <br /> PUMP REPAIR: / / State or Dorm�--� <br /> DESTRUCTION OF WELL: Well! ] iam a 1A0 Appro e 'opth <br /> je1jibe terial and Pr cedure <br /> I hereby agree to Wly Wittall 1 st regu ations of th n Joaquin a e th District <br /> and the State of California er aj. X to or regulati well construction n IFTEEN DAYS <br /> after completion of my wor new well I wil�f�' the San Joaqui a e th District a <br /> WELL DRILLERS REPORT of the 1 and otz +lbefore putting the well i. a above <br /> information is true to the best of ge and belief. <br /> SIGNED TITLE ff er <br /> RAW PLOT PLAN ON REVERSE SIDE) <br /> FOR DEPARTMENT USE ONLY <br /> PRASE I _I <br /> APPLICATION ACCEPTED B �,��C E6?,/,_ <br /> „ <br /> ADDITIONAL COMMENTS: V\ Ji <br /> PHASE II GROUT INSPECTION PHASE II /FINAL INSPECTION <br /> INSPECTION BY DATE INSPECTION BY DATE <br /> CALL FOR A GROUT .INSPECTION PRIOR TO GROUTING AND FINAL INSPECTION. <br /> E H 1426 4/72 1M <br />