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SAN JOAQU I N COUNTY Pl IBL I C 11EAJ.'rI1 :;ERV I CES }2i(V I RONYISNTAL IIEAI.T11 DIVISION •145 N SAN JOAQU I N , 1)11CN E (2109)-168-3420 P O BOX 2009, :;T(X'KTON , CA 95201 WELL No. 6 PERMIT EXP I RE3 1 YEAR FROM DATP I SSU M (Compinrte in I'rlpllcate) Appllcsttoo to hereby made to San Joaquin County for a permit to construct andJnr :r.stal: the v:;rc h•retn desertb.d. -.3 19 application to Dade In eaeplllrlee with San Joaquin Cn•ufty Ordlnenre No. S49 and 18b2 and the Rules and Regulattoue of San Joaquin County Public Health Service*. Joo Addrets 942 -> • Stockton Avenue ___ _ L•Iy j4 CLrL _ Get 5::�!•tcr�agc Owner's Nam" _ Simpson 13goor CO. AC.fiets �.�.��_.`2tOS�at.f�IL1iVr' Phone(?E14) r,r19-d; d l Lawrence Daviel A. Inc, :(il)a Ril)on, CA 9536 (916) Conttactorl,,dWT'G1CC_��j zSQ.G.._ Aoorest 2001 Mar St. Rin � rise rte �_YfYy!'C`lPeone 244=D7113. �+ -T•h TYPE Of WELL/PUMP NEW WELL "-� .: a HEr,A;=.ttF'iT !" DtSTItUCTION Out of Service 4e!:Ll PUMP INSTALLATION�3 ` SYSTLM REPAIR OTHER Monitoring -dell C OISTANCE TO NEAREST: SEPTIC TANK > 1000 SEWER LINES OISPGSAL F10 Z1L.UGf-+snP Ul,-E " 10 0' FOUNDATION AGRICULTURE WELL _ OTHER WELL 2 1 n - PITS/SiJMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRtJCTION SPECIFICATIONS Q( Industrial ❑ Open Bottom u Manteca 0.6 of Well Eacavaton D.a of Well Casing 171 Domestc/Prwate O Gfs,* Paco M Tracy Type of Casing_ _ Specifications I'I P"blic fl. Other 11 Delta Depth of Grout Seat Type of Giout I I lllIU411-W , Approx. Depth I I Eastern S„rlaee Swt Insia4d by Repair Wok Done U Type of Pump H P. State Work Done — W'eH Destruction O Well Diameter Seal i rig Ma t.e r L a1 A Depth Depth Tiller Material M Depth TYPE OF SEPTIC WORK. NEW INSTALLATION i I REPAIRrADOITION . DESTRUCT,ON I : 1N0 septic systam perm,Ited d ptibkc www IS availaaa ..thin 200 fool.) Installation wA serve: Residence _ Commercial _ Number of hying un Is: _ Number of bedrooms _ Cheracter of sat t a a depth of 7 test: SEPTIC TANK 0 Type(M19 PKG. TREATMENT PLT. O Other Capacity Distance to nearest: Well — Foundation LEACHING LINE Cl No. • Le09th of tines FILTER BED 0 Distance to nearest. Wee _ Foundation Water tab4 tiepin No. Compartments Method of Disposal Properly Lias Total Iength%sire Property Line ScEPAGE PITS 1 I Depth Sire Number SUMPS LI Defiance to rte~est: Wad Foundation Property Law DISPOSAL PONDS Cl 1 hereby eenity, that I have prepared ins application and trial Iry wo-k wie W clone in accorCance with San Joaquin county ordinances, state laws, and rules end rogwLetiorn of the San Joaquin County Home QW#TW Or WOASW apMt's aipnature cer't;fies the Ioeowinq "I CSrtdy that ,n the performance of the work for .t+ich this permit O issued. I oali not erT•ploy My pwwn in Such Rion~ as to become subpct to workman It cornpentahon taws of Cab101oia " Contractor's 11.1109 or sub•c0ntractin9 si9n4tur6 eartAiee the follow N: "I certify tat M the performance of IM .ork for which this permit -S issued. Isola employ pennons subject to workman's compensa- tion leyws of CaMorNa.'• Ta applicant st Ca 10, Sit rroWK04 wspechons. Complete Crewing on reverse We $pnW i �I''! CkIt Title Pre:udent Data: 12/ 0/92 FOR DVAfRTMIXt Uii hiLY Appliutgn Accepted by ``t- ^'-� Date --1,G --� Ar Pk at Grout Inspection by Addrtanal Coff~ts: Applleant - Return all eopiea to: i t th 1}7s tafw. vat 1" n4.38 Date Fuul )napes tion by -, 'd'^r Deter% Son Joaquin County Public Health Services Cevtroonental Health PerialtlServices 4 5 Al Sae Joaqula, P O Boa 2009, Stkn, CA 95201 FEEAMOVNT NFO DUE AMOUNT REMIT-7EO LK RECEIVED By DATE PERMIT NO r