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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES [ , Q ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made 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. Job AddrAP60 Archerdale Rd, City TJ ndpn Lot Size/Acreage 90 Owner's Name James Ferrari Address 5960 Archerdal e Rd_ Phone ContractopurVianCe Drillers,A7yPOB 64 ,Linden License No.377923 Phone -1554 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENTXk DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION X SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C7 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 n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 12 r Dia. of Well Casing _Nczs, A] Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing steel Specifications* 13 4 � I'1 Public El OthSr n Delta Depth of Grout Seal 250 Type of Grout C m I I Irrigation 3_aOkpprox. Depth I I Eastern Surface Seal Installed b, SK Repair Work Done U Type of Pump sub H.P. 1 1 /2 State Work Done Well Destruction ❑ Well Diameter Sealing Material & Depth Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I 1 DESTRUCTION I I INo 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 O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE CI No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 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." Contractor's 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 required inspections. Complete drawing on reverse side. Signed ./ '~, wzv.{. -c- Title: Corporate SecretarX Date: 7/21 /93 ( FOR DEPARTMENT USE ONLY Q Application Accepted by / Date Area (� 1 +� Pit Grou Inspection b DateI/I Final Inspection by 'Xf Date / J Additional Comments: ` 04/ fa Applicant - Return all copies to.-)San Joaquin County Public Health Services Environmental Health Permit/Services V �D 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 �OU IFEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE "PERMIT'NO.EH 13.24(REV.I/Na) W f< ,EH 14.26