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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 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 made in compliance with San Joaquin CountyOrdinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 6302 Foppiano Ciry Stkn Lot Size40 Acres pM Owner's Name Joe Solari Address same Phone 931 1765 Contractor Clark Well Address 2024 E. Charter _aXicense No. 371 560 Phone 462 7676 TYPE OF WELL/PUMP: NEW WELL P9 WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTA4ATION SYSTE R AIR ❑ * U(f 7 ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD.'5(fU PROP. LINE }5 0 0 r FOUNDATION AGRICULTURE WELL OTHER WELh�c' PITS/SUMPS M? INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial �Open Bottom ❑ Manteca Dia- of Well Excavation �4 rt Dia. of Well Casing 12 3/4 rr ❑ Domestic/Private (Gravel Pack ❑ Tracy Type of Casing Steel Specifications. 18 8 f'l Public ❑ Other ❑ Delta Depth of Grout Seal None Type of Grout -- W IXlrrigatian __Approxnth i I,Eastern Surface Seal Installed by C1 ark _ Repair Work Done ❑ Type of Pump !t/kl'�[] H.P. 30 State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION ['I REPAIR/ADDITION I t DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial _ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mtg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line i SEEPAGE PITS FI Depth Size _ Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 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 rules and regulations of the San Joaquin Local Health District. 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 pcl ner as to become subject to workman's compensation laws of California." Contractors hiring or sub-contracting signature certifies the following 'I certify th in the rforma ce of the work for which this permit is issued,I shall employ persons subject to workman's compensa- tion laws of Cali mi The applican t or a r ired n o . C mplete drawing on reverse side. Signed X Title:VP Clark Date: 17 Aust 1988 /}.� FOR DEPARTMENT USE ONLY Application Accepted by __ �t J t (A Date Area Pit or Grout Inspection by Date Final Inspection by / Date &S, Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Heafth Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED 4 RECEIVED BY /DATE PERMIT'NO. +. CASH EH 13-24(REV.r/H E •35 C\1_1 ✓1 •� J J EH 1426 1 LLU�� ((��((LJJ1 lar► r. „