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V I APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone {209) 466-6781 (..... v PERMIT EXPIRES TYEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District 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 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. f Job Address 15327 S. 7th Street City Lath=° Lot-Size 50' s 145' PM p.! i1I; Owner's Name .Gene Navarra Address 15327 S. 7th Street Phone 982-4842 j� 11290 Vallejo Ct. ContractorVallajoCoast. Luc. Address breech Camp, CA 95231License No,479838 982-5661 Phone TYPE OF WELL/PUMP:. NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION Cl PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private 06tavel Pack ❑ Tracy Type of Casing Specifications 171 Public ❑ O 1 ther _❑ Delta Depth of Grout Seal Type of Grout f ��A rox. Depth l I Eastern. Surface Seal Installed b k lil Irrigation ppy Repair Work Done ❑ Type of Pump H,P. State Work Done Well Destruction ❑ Well'6ameter Sealing Material atop 50') Ln Depth Filler Material {Below 501 ray TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 - REPAIR/ADDITION l l DESTRUCTION$I (No septic system permitted if public sewer is L/u II t available within 200 feet.) N Installation will serve: Residence 1 Commercial_ Other, Number of living units: V Number of bedrooms Character of soil to a depth of 3 feet: Water table depth , SEPTIC TANK A T6ype/Mfg COMOUt Capacity 41*1110WO No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal ; Distance to nearest: Well Foundation Property Line II. LEACHING LINE ❑ No. & Length of lines Total length/size # FILTER BED ❑ Distance to nearest: Well Foundation Property Line 0. <r SEEPAGE PITS l I Depth Size Number SUMPS Irl Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ Ill, 1 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 SA Joaquin Local Health District. 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 mariner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify,, hat 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 applican must call for all required inspections. Complete drawing on reverse side. Signed X I� Title: _ _- Date: �� 6 . FOR DEPARTMENT USE ONLY Application Accepted by i Date Area �``� Pit or Grout Inspection b �� Date Final Inspection by Date//4w ., Additional Comments: 'F CIStk 466-6781 C1Lod, 369-3 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant- Return all copies to Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 CK 9 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PER MIT•NO. + EH 13;24 IREV.t i k 5) E14 14-26 SII S l + ✓ l 1 II _ j