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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT Ij 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 FEB 7 1 PERMIT EXPIRES 1 YEAR FROM DAT_ E_ISSUEDENVIRONNIENNAL HEWN, (Complete in Triplicate) PERMT/SERVICES 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 County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local.Health District. Job Address 5950 E. Woodbrcjty Lot Size PM Owner's Name ROBERT MONDAVI WINERY Address5950 E. Woodbridge Rd. Phone P.O.Box 113 Contractor Goehring Pump Address Lockeford Ca. License No. 309031. Phone 727-5548 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION IR SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS w ❑ Industrial ❑ Open Bottom ❑ Manteca Dia- of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications * Public Cl Other ❑ Delta Depth of Grout Seal Type of Grout—.-- i rout .I I Irrigation ---Approx. Depth I 1 Eastern Surface Seal Installed by _ Repair Work Done X3 Type of Pump Ste. H,P. 71/2HP State Work Done rep- aced 20HP turbine Well Destruction ❑ Well Diameter' " ""`Seating Material-Rc p'50'i" - bepth- =.-Filler-Material (Below-501- TYPE Below-501 TYPE OF SEPTIC WORK: NEW INSTALLATION l 1 REPAIR/ADDITION I 1 DESTRUCTION ! I (No septic system permitted it public sewer is Q 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 I SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Prop erty.Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well `"foundation Property Line .� v SEEPAGE PITS 1. 1 Depth Size Number SUMPS Cl 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 Di$trict. Home owner or license gent's signature certifies the following: "I certify thai in the performance of the work for which this permit is issued, I shall riot employ any person in u manner as to become subject to workman's compensation laws of California."Contractor's hiring or sub-contracting signature certifies the follo 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 Cal- r i ' The applican 1 II required inspections. Complete drawing on reverse side. Signed X Title: Bkpr. Date: 02/06/90 FOR DEPARTMENT USE ONLY J Application Accepted byI�22 Date Area Pit or Grout Inspection by Date Final Inspection by `/1 / t_-f 4- ?� Data 2- r Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Rn Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95.201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMITNO. INFO CASH +.EH 13-21(REV.t i n 51ap � - �q r 0 EH 14-26 '�+b