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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES . 'L /I 2 �� ENVIRONMENTAL HEALTH DIVISION ( 445 N SAN JOAQUIN, PHONE (209)46$-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES I YEAR FROM DATE ISSUED (Complete in Triplicate) Application Is hereby made to San Joaquin County for a permit to construct and/or install the stork herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San fJoaquin County Public Health Services. /+ Job Address 3500 N. Beecher Rd. City$ g Lot Size/Acreage kXA -Don Ghi Ile�ri Owner's Name g. � Address 3500 N. Beecher Rd_, Stockton Phone CorIpgroyiance Drilles, Inc. Address P.. 0. Box 64,Linden,,Ca License rqo.377923 _ Phone ' -3554 TYPE OF WELL/PUMP: NEW WELL rw A WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ PUMP INS ILLATION SYSTEM REPAIR Ll 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 Dia. of Well Casing C] Domestic/Private ❑ Gravel Pack7 0 Tracy Type of Casing_ steel specifications 188 ._._ I'I Public (] Other n Delta Depth of Grout Seal . 240 t 231 Type of Grout C m ( p� XXIrhoation 4K.Approx. Depth 1 1 Eastern Surface Seal Installed by V� Repair Work Done L) Type of Pump H.P, State Work Done Well Destruction ❑ Well Diameter-' M Sealing Material & Depth Depth Filler Material b Depth 0 TYPE OF SEPTIC WORK; NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I iNo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial— Other t Number of living units: Number of bedrooms " Character of soil to a depth of 3 feet: _. - —Water table depth SEPTIC TANK.; ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ - i Method of Disposal Distance_ to nearest: Well Foundation Property Line i LEACHING LINE�L-�-.._No, &_Length of lines Total-length/size FILTER BED n Distance to nearest. Well Foundation Property Line n i SEEPAGE PITS I I Depth Site ""'- -- Number 1 SUMPS EI Distance to nearest: Well Foundation M Pioperty 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 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 t 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 plicant m t call I equir inspections. Complete drawing on reverse side. Signed Title: . CctT�xtt'atr� x� arV Date: 11/4/92 FOR DEPARTMENT USE ONLY Application Accepted byc� st,�r,f Date I ILL. � Area_ j Z Pito Grou 1 spaction by 14 J A111i Date t r1rrFinal inspection by Date Additional Comments: 6e Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE )NFO AMOUNT DUE AMOUNT REMITTED GASH RECEIVED BY DATE PERMIT'NO, a , + EH 13-24 lREV.I IOs51 {• �� Q , t7 ga- EH 14.25 ` h�i. -"l+^1 Z