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kAft SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES II ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 KT JOB 20-3157-03 l I PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) II Application is hereby made to San Joaquin County for a permit to construct and/or install the vork herein described. This application is made in compliance vith San Joaqu' Cunt Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin Coun y Public Health Services. APA 12"3 490-01 YOSEMITE SQUARE 1338 W. Y6S6P71M /WE, Job Address SEC Yosemite & Grand rix Aves City. Manteca Lot Size/Acreage P.O. Box 1265,Manteca,CA 95336 209-239-3525 Owner's Name P.G. Fr Properties, Inq�ddress Ph... 1d Contractor Spectrum/Kleznfelder Address 2825 E.Myrtle St License No. 512268 Phone948-1345 TYPE OF WELL/PUMP: 11 NEW WELL 0 WELL REPLACEMENT R DESTRUCTION-Lt Out-af--'er ft"se irel-r-I3— PUMPiINSTALLATION ❑ SYSTEM REPAIR-D OTHER XX 1Aon-1T r-ir1Kwell _01— DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. -PftefL., -�NE Nest Borings FOUNDATION AGRICULTURE WELL OTHER WELL -PfTS1L9tfMIPe- J-1-20 ft.deep INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 6`r diameter ❑ Industrial 0 Open Bottom ❑ Manteca Dia- of Well Excavation W4+ehq%=CaglaT fa Domestic/Private 0 Gravel Pack ❑ Tracy Type of Casing_ 9peicifit aDons I I'I Public C1 Other n Delta Depth of Grout Seal Type of-Groat I I Irrigation Approx. Depth l I Eastern Surface Saw Installed by If groundwater encountered, Repair Work Done 0 Type of Pump H.P. State Work Dona , wild backfill with Well Destruction O Well Diameter Sealing Material 16 Depth "hole_-Plug S OeptO Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDITION I I DESTRUCTION I i iNo septic system permitted if public sewer is �. d, available within 200 feet.) Installation will serve: Residence Commercial_ Other Number of living units: i�.Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. 0 Method of Disposal �- Distance to nearest: Well -Foundation Property Line �\ II LEACHING LINE 0 No� & Length of lines Total length/size ` FILTER BED n Distance to nearest: Well Foundation Property Line 1� SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest; Well Foundation Property Line DISPOSAL PONDS 113 ii. 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 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 st call for re red inspections. Complete drawing on reverse side. t `• Title: Engineering Geologist Date: 23 1992 Signed X II OR 019PARTMENT USE ONLY 99911Pr �] Application Accepted by Date A a Pit or Grout Inspection by ' Data Final Inspection b � Data f Additional Comments: i Applicant - Return all- copies to: San Joaquin County Public Health Services Environmental Health Permit/Services I . 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK V RECEIVED BY GATE PERMIT NO. INFO • EH13.24 tREV.1/0 so i EH 74.211