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SAN JOAQUIN COUNTY PUBI,IC _HEALTH SFTVICES ENVIRONMENTAL HETI` DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 , - - —c "'PERMIT EXPIRES 1 YEAR FROM DATE ISSUED _ G-314 S ? (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. �rj-Q$Q�l3+14 CC Joh AddressfdptS' th+ « "�8�1ZWe* 5• City T1C Lot Size/Acreage .x Z0J kQIb>494- 3,319 Owner's Name -Tre,&_ &_ms Address T d &Y 1330 �� - 96913 Phon916 84 r ZB 1 {. 95a5i 34 q1&)484-332 Contractor Te�1_ Addfessf O•� 1rMZ �tGm T>IW License No. TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 0 DESTRUCTION ❑ Out of Service Well ❑ - PUMP INSTALLATION ❑ - SYSTEM REPAIR 11 OTHER )C�i ° ift tori 3f.4 v �(.�1�15 (36� DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS—— '+401 1461 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open`Bottom © Manteca-•+ Dia..of Well.Excavation _ Dia. of Well Casing irb o -S �[I Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing= r Specifications - Cl Public Cl Other Cl Delta Depth of Grout Seal Type of Groul t I Irrigation —Approx. Depth I 1 Eastern Surface Seal installed by Repair Work Done 0 Type of Pump H.P. State Work Well Destruction ' ❑ Well Diameter Sealing Material & Depth $t Do tib u1Q. r' Depth Filler Material 1 0110 _5WW&Rf � Gh� 1JV TYPE OF SEPTIC WORK: NEW INSTALLATION I ) REPAIR/ADDITION [ I 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/Mfg Capacity No. °° PKG. TREATMENT PLT. ❑ MetFdf i Osa Distance to nearest: Well Foundation Property LIR ry LEACHING LINE ❑ No. & Length of lines Total length/size IV' S TV L e�aA I FILTER BED [,1 Distance to nearest: Well Foundation ProPerfy' ��'EZVICF_S - pUBLlC I SEEPAGE PITS 11 Depth Size Number ��V1 SUMPS CI 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 Iha:San Joaquin-County. H°me owner or licensed agent's signature cenifies 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 taws 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 t nne Title: &0,06C114MlnfZrJ-5 date: !!&N 5, 1 qg2_ -J - FOR DEPARTMENT USE ONLY Application Accepted by Date 15 Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant —Return all copies to: San Joaquin County'Public Health Services Environmental Health Permit/services 445 N San Joaquin, 0 Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REM1TTEt] CK RECEIVED BY DATE PERMIT'N0. INFO ��yy+ y� jy�J� j�j . EH13.241REV.tiN51 �g V ! `( � ALJ f f �'� L� �� ` EH 14.16