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87-807
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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87-807
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Last modified
11/26/2019 10:10:22 PM
Creation date
12/3/2017 1:29:16 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
87-807
STREET_NUMBER
5273
Direction
E
STREET_NAME
MARSH
City
STOCKTON
SITE_LOCATION
5273 E MARSH
RECEIVED_DATE
03/18/1987
P_LOCATION
ERNEST LEMONS
Supplemental fields
FilePath
\MIGRATIONS\M\MARSH\5273\87-807.PDF
QuestysFileName
87-807
QuestysRecordID
1845973
QuestysRecordType
12
Tags
EHD - Public
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APPLICATION.FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE.,:STOCKTON, CA ,, <br /> Telephone (209) 466-6781 <br /> 1IPERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> « <br /> 1 (Complete in Triplicate) k�f <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 /> 7 f� S <br /> Z C7 ' <br /> Job Address i! City Lot Size �O, PM <br /> 1 <br /> l i�' /�/( 'StZ <br /> Owner's Name 4 F A—�-"J ,��""�✓Address l Phone ; <br /> SL�", Address License No. Phone <br /> Contractor -- ( (\ <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ " \I <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK., SEWER LINES DISPOSAL FLD. PROP. LINE \ 't <br /> F, V <br /> FOUNDATION'. AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL —PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Ll Industrial ❑ Open Bottom D','Manteca Dia. of Well Excavation Dia. of Well Casing <br /> ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy; Type of Casing Specifications ` <br /> ❑ Public ❑ Other ❑ Delta `s ,'fDepth of Grout Seal <br /> Type of Grout <br /> El Irrigation ---Approx. Depth C1 Eastern Surface Seal Installed by I <br /> Repair Work Done ❑ Type of Pump H.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material atop 50'1 _r <br /> Depth. Filler Material (Below 50.)"E _ <br /> I ~ f <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTIO (No septic system permitted if public sewer is <br /> 'available'wiithin 200 feet.) <br /> Installation will serve: Residence Commercial_ Other 1 <br /> Number of living units: _ Number of bedrooms <br /> Character of soil to a depth of 3 feet Water table depth <br /> SEPTIC TANK ;c.rTypelMfgr ^4 �~ Capacity O O (� No. Compartments <br /> PKG. TREATMENT PLT. ❑ j �+ �..� .� J Method of Disposyl L <br /> Distance to nearest: Well Foundation Property Line — <br /> 4 LEACHING LINE J21 No. & Length of tines d Total length/size <br /> 1610 <br /> FILTER BED Distance:to nearest: Well _101—Fou ndation, t'Property Line <br /> fI <br /> SEEPAGE PITS ID Depth I Size Number <br /> SUMPS _ Distance <br /> 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 stgnature <br /> certifies the following: "I certify that in the performance of the work for which this permit is issued,1 shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicanlmust call for_qII requ red inspections. Complete drawing on reverse side. <br /> ' _ .off /i�7'e�s Title:' tlol Date: •.1 <br /> Signed X <br /> FOR DEPARTMENT USE ONLY <br /> Application Acceptedby Date ` Area <br /> Pit or Grout Inspection Date Final Inspection by Date <br /> Additional Comments: <br /> I ❑ Stk 466-6781 ElLodi 369421 171Manteca 823-7104 ,O Tracy- 835-6385 <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. HazeltonfAve;y P.O.;Box 2009,Stk., CA 95201 <br /> FEEASH <br /> -AMOUNT DUE AMOUNT REMITTED RECEIVED BY ' DATE PERMITNO. <br /> INFO <br /> + EH 13-24 IREV,i <br /> EH 14-26 <br />
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