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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 4 ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOC%TON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is here made to San Joaquin Count for e - 1?P by q y 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 Address 17477 E. Hy 120 City- upon Lot Size/Acreage300 X 270 1rr. Owner's Name Robert Imfeld Address 17477 E. Hy. 120 Phone 838-7536 Contractor Garner Const. Address 7900 Wren Rd. , Oakdale License N,441868 A-B Phone847-3480 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 171 DESTRUCTION D Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE HVECL" • OTHER WELL PITS/SUMPS T INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation pia. of Well Casing * Domestic/Private ❑ Gravel Pack C7 Tracy Type of Casing_ Specifications I'I Public El Other " Cl Delta Depth of Cfrout Seal Type of droyt 'I I Irrigation _.,ApproK. Depth 11 Eastern Surface Seal Installed by i`"`''• � '� y +' -Repair Work Done U Type of Pump I H.P. w" State..WorkeQR*.le Well Destruction ❑ Well Diameter '# Sealing Material &-.Depth'. } Depth Filler Material �th ^, } � 4 TYPE OF SEPTIC WORK: NEW INSTALLAy I REPAIRlADDITION X DESTRUCTION I I INo septic,systerFi;, tted iG'prdplic sower is �s;:AML.•,.+ aydilaOl wyi lift 2 eet.I ' ° (� F Installation will serve: Residence X Coial_ Other "Number of living units`: __ `Numlie`r ofoms Character of soil to a depth of 3 feet: H& d n, a rlrr&.• S r Water table depth 100 ft. P1uS �•-v . . + SEPTIC TANK ❑ Type/Mfg S11)� fCapacit�'" No:Combartrnants PKG. TREATMENT PLT, ❑ Mefhod,6t.Disposal (Mare(Marellp nearest: ell 120 t.Foundeling,130 Property Eini '60 ft PluS LEACHING LINE xl \,NX.. &kAeehgth o ii e ' 40'X I _•�'rJ �OIIE Total 4 six ne '"_ '' 80 S ft. FILTER BED Cl Dis nce t a st: - "-"W I v Foundation a Prop rty Line '', SEEPAGE PITSI Depth 1 Size 14 X 3 X-10 Number one $ SUMPS iI Distance to nearest: Well 120 Foundation 130 Property Line 50-Plus 1 DISPOSAL PONDS ❑ ' I hereby certify that I have prepared this appli tion and that the work will be done in accordance with San Joaquin cdun ordinances, state laws, and _ rules and regulations of the San Joaquin CErmie ty Boma owner or licensed agent's signature ' fies the following: "I certify that in the performance of the work for which this permit is issu�ed, I shall not employ any person in such manner as to subject to workman's compensation laws of California." Contractor's hiring or sub contracting signature certifies the following: I certify that in rformancs of the work for which this permit is issued, I shall employ " " M p p y persons subject to workman's compensa- tion laws of California." The applicant mus call f r al r uired inspections. Complete drawing on reverse side. "`""'+ ar Signed X _,.� Title: Date: LL_ !16 * OR DEPARTMENT USE ONLY l Application Accepted by r^ Dale �^ t 'L 2" AreaJ_1_ Pit or Grout Inspection by Date Final Inspection by - Date Additional Comments: p r Applicant - Return all copies to: San Joaquin County Public Health Services { r Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE1 INFO AM0 NT DUE" AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. .f . EH13.2�IREV.riKSi .� S �! tD� C0o � 4- EH 12a �� M