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86-281
Environmental Health - Public
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HEWITT
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4200/4300 - Liquid Waste/Water Well Permits
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86-281
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Last modified
9/7/2019 12:01:50 AM
Creation date
12/2/2017 3:39:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
86-281
STREET_NUMBER
365
Direction
N
STREET_NAME
HEWITT
STREET_TYPE
RD
City
LINDEN
SITE_LOCATION
365 N HEWITT RD
RECEIVED_DATE
04/07/1986
P_LOCATION
WANDA TURNER
Supplemental fields
FilePath
\MIGRATIONS\H\HEWITT\365\86-281.PDF
QuestysFileName
86-281
QuestysRecordID
1750276
QuestysRecordType
12
Tags
EHD - Public
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{ <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT C <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. TMs 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 /> 36 ,�Job Address s City f Lot Size PM <br /> Owner's Name ��fii11/rLAl� Address �..� /+' f ' _ Phone 7_30 <br /> � r <br /> Contractor's Name se No. i7 <br /> Phone 2' <br /> TYPE OF WELL/PUMP: EW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ <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 l- Manteca Dia. of Well Excavation Dia. of Well Casing <br /> F ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications <br /> ❑ Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout <br /> ❑ Irrigation ---Approx. Depth ❑ Eastern Surface Seal Installed by <br /> Repair Work Done ❑ 'Type of Pump H.P. State Work Done <br /> E Well Destruction ❑ Well Diameter, Sealing Material (top 50') 1l <br /> Depth Filler Material (Below 5016 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1P REPAIR/ADDITION ❑ DESTFjJrCT ON (No septic system permitted if public sewer is v I <br /> f� ailable within 200 feet.) <br /> Installation will serve: Residence— Commercial_ Other O <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feet: Water table depth <br /> .SEPTIC TANK T ' <br /> ype/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ /. Method of Dispos <br /> _ Distance to nearest: Well T/.` /��_ Foundation Property Line <br /> E YL� <br /> LEACHING LINE (!9 No. & Length of lines To I length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation 2 Property Line2 0 ' <br /> SEEPAGE PITS Q Depth <br /> Size N mber ! <br /> SUMPS ❑ Distance to nearest: Well Foundation ._ property Line <br /> DISPOSAL PONDS. ❑ <br /> 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, 1 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 employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applica must call for II req red inspections. Complete drawing on reverse side. <br /> Signed Title: Date: <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by <br /> Date Area <br /> Pit or Grout Inspection by4�i Date `f' . Final Inspection by Date /~ / <br /> t G <br /> Additional Comments: <br /> L7 Stk 466-6781 ❑ Lodi 369-3-6211 ❑ Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1661 E. Hazelton Ave., P.O. Bax 2009, Stk., CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED CK <br /> INFO CASH RECEIVED BY DATE PERMIT"NO. <br /> +EH 1428 ��EH 13-241REV,10/831 <br /> d� ■ <br />
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