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: APPL•ICWT07 A - SAN JOAQUIN COUNTY PUBLIC BNVIROM ENTAL HEALTH SERVICES 445 N SAN JOAQU IN, PHO E$ (209)468-3420 I:d 'U! P 0 BOX 2009, STOCKTON, CA 95201 PERI MAY 12 1993 E%PIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) ENVIRONMENTAL HEALTH application is hereby made to San Joaquin County fora permit to construct and/or install the work herein described This application is made in compliance with Ban .Toaquin county ordinance No. 549 and 1862 and the Rules and Regulations of San [! oaquiO County Public Health Se�Oce6, i Job Address DDRW-Trac , So. Christman Rd IIII City Trac Lot size/Acreage 448-a r Defense Lo istics A enc DDRW- Sharpe, Roth Rd, owner'. Name YAddress Lathro CA Marshall Cloud S 30,., -- Phone Contractor Gre Drillin -4 Address42 Berr Dr PachecoCA TYPE OF WELL/PUMP: NEW WELL ❑ License No,C574$S1C5 phones WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ J42 soil DISTANCE TO NEAREST: SEPTIC TANK orin s OTHER ® No i weeng 4ie11 SEWER LINES — DISPOSAL F LO. NE weliS FOUNDATION AGRICULTURE WELL '-� PROP. LINE OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrie—i~' ❑ Open Batt ❑ Man C7 Domestic/Private Die• of Wall Excavation ,r IA Gravel Pack Dia. of Well Casing f'1 Public n Tracy Type of C"ng_Sch 40 vc Specifications-4_�� f Other borings f 1 Delta Depth of,Grout Seal 20' ave'. + I frrit]atipn 30_'Approx. Depth ! I Eastern Type of Grout Repair Work Done (] T Type Seal installed byCola t! Type of Pump N_A _ H.P. Cement Well Destruction ❑ Won Diameter NSA Sealing Materiel i Depth State Work Done f nth tiller Depth Material f, TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I 1 DESTRUCTION I I INo sepric system Installation will serve: Residence, available within 2" Wm t'ed it public sower is U 1 Commercial, Other Number of living units. Number of bedrooms Character Of sail 10 a depth of 3 feet: SEPTIC TANK. ❑ Type/Mfg Water table depth PKG. TREATMENT PLT.❑ Capacity—_ No. C roonments f Distance to nearest: WeBFoundation pMethod of Disposal --��. k LEACHING LINE Q No. 3 Length of lines roperty Line FILTER BED 0 Distance to' Total length/size �'�t' Wag—.-�_ Foundation --».� Property Line SEEPAGE PITS 11 Depth SUMPS S'� Number LI Distance to nearow: WeB DISPOSAL PONDS ❑ �— Foundation�� pMM,ry Line I hereby terrify that I have preparoq this application and that the work will be done in accordance with San rules and regulations of the San J oacluinHome Owner or licensed agent's signature County Joaquin county ordinances, state laws, an f� employ anage �ignela b osrti e6 the following: l certify that in the performance o!the work for which this Lf J Y person in such nrsnner u to became su r certifies the fo4owi bled to workman's compensation(Pars rr Cn"Of is." permit is issued, I shell not tion laws of California."niI artily that nt tM pertorntenca of the wok fw which this Contractors hiring o sub-contracting signature permit is issued.I shalt employ Persons subiect to workman's eon"nsa- The applicant must call for all requ' in ice. Com plate drawing an reverse Bide. Signed , ' Title: Prnient HaTtatter pate: 5 10 93 FOR DEPARTMENT USE ONLY Application Accepted by �� Date Area Pit or Grout Inspection by �Z'�Finsl Dateonby ._ cr 2 Additional Comments; Data Applicant - Return all copies to: San Joaquin Countg Public Health ServicesEnv al Health ces 4453 NoSannJfoaquin, p 0 Boxt2009,r3Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED INFd CASH RECEIVED BY �J/� /� +p DATE PEflMfT'NO. EM 14.2 frllV.r�r+6Y ll "/ ��-1. IIQO�� EN 11•a) CCJJ