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r SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby trade to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Q J 7 City Lot Size/Acreage ob Address Owner's flame rens Phone YConl,;ctor Addre s License Ko. Phone YPF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT (7 DESTRUCTION ❑ Out of Service Well G1 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER C1 Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK EWER LINES L FLD. PROP. LINE FOUNDA N AGRICUL�T� OTHER WELL PITS/SUMPS INTENDED USE TYPE F WELL PROBLEM-AREA CONS TRU NS_. (} Industrial ❑ Ops. Bottom -❑_Manteca Dia. of Well Excavation Dia. of Well Casing L _� C] Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications I'1 Public f-1 Other n Delta Depth of Grout Seal Type of Grout `^ I I Irrigation _Approx. Depth I } Eastern Surface Seal Installed by �l Repair Work Done ❑ Type of Pump H.P. t State Work Done Well Destruction ❑ Well Diameter Sealing Material 8 Depth Depth Filler Material 6e Depth I t TYPE OF SEPTIC WORK: NEW INSTALLATION R I REPAIRIADDITION I ! 1)1 ESTRUCTIO071No septic system permitted if public,sewer is t b t available within 200 feet.) 0 1 ' Installation will serve: Residence Commercial_ Other I Number of living units: Number of badrpoms r f # Character of soil to a depth of 3 feet: t` ! Water labra depth 1 f SEPTIC TANK ❑ Type/Mfg # Capacity_ No. Compartments �p PKG. TREATMENT-PLT. b- } � Method of Disposal Distance to nearest: Well Foundation Property Line \V Ft' LEACHING l • f f 0 rNo. & Length of lines Total length/size FILTER BED D .Distance to nearest. Weil Foundation Property Line rf v SEEPAGE PITS 11 Depth Size Number t e i ,s SUMPS LI Distance to nearest: Well Foundation Property Line ^' I DISPOSAL PONDS D t `" ! I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and s rules and regulations of the San Joaquin County 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, -- employ any person in such manner as to become subject to workman's compensation laws of California." Contractors hiring or sub-contracting signature- 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�; tion laws of California." The applicant must call for all feguired inspections. Com Tete drawing on Signed X Title: lg-�. ___ Date: t f is FO DEPARTMENT USE ONLY f eq Application Accepted by # Dare T L Z"=�- Area Pit or Grout Inspection by ) Date Final Inspection by w s Date t r. Additional Comments; s- �� -f k ai e i 0-e.d Applicant - Saturn all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 F FEE INFO AMOUNT DUfi AMOUNT.REMITTED_ C4SFt "� RECEIVED BY --DATE' — ' PERMITNO: 1 . EH 13-24 TREY.tiHsi 'rS710 DD EH 11.20 f