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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E. j-IAZEL T ON AVE., STOCKTON, CA Telephone 1209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED MAR 2 Q 1 0 (Complete in Triplicate) 1-NVIRONMENTALpp�"�EA HEALTH i Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work hereiF ft}"eT/ 5pplsroA-&n 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; r Job Address 25150 N. Sowles Rd. City Lot Size PM Owner's Name JACKSON MOREHEAa Address 25150 N. SOwleS Rd. Phone 17.754 N. Hwy. 88 Contractor Goehrin Pump- Address i_ockeford Ca. License No. 309031 Phone 727-5548 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR XX OTHER ❑ P DISTANCE TO NEAREST: SEPTIC TANK SEWER,LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS INTENDED USE TYPE OF WELL PROBLEM AREA M6TRUCTION SPECIFICATIONS'' ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications M Public ❑ other El Delta Depth of Grout Seal Type of Grout-----. i I Irrigation —_Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done XK Type of Pump Turbi_t].E~...-. H.P. 25 State Work Done_ repair , Well Destruction ❑ Well Diameter Sealing Material (top 50') N Depth Filler Material fBelo"_I. — TYPE OF SEPTIC WORK: NEW INSTALLATION 11 REPAIR/ADDITION 11`f DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) 0 Installation will serve: ,Resid'ence_ Commercial_ Other , r Number of living units: i Number of 6ediooins .! * Character of soil to a depth of 3 feet: _ - Water table depth SEPTIC TANK 0 Type/Mfg C Capacity No. Compartments r PKG. TREATMENT PLT. 171 of Disposal Distance to nearest: Well Foundation Property Line 0 LEACHING LINE ❑ No. & Length of lines f Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ o - - - --4 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 San Joaquin Local Health District. Home-.owner or-licensed agen'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 perso-Wiri such rier as to become subject to workman's compensation laws of California."Contractor's hiring or sub contracting signature certifies tLfollowing: " rfy that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa tion lawsforn�The appliu all r wired inspections. Complete drawing on reverse side. Signed X Title: Bkpr.. Date: 03/16/90 FOR DEPARTMENT USE ONLY �J J Application Accepted by Date 3__ Area / Z Pit or Grout Inspection by Date Final Inspection by -Gdh1L2enM=i=fz2 Date) F Additional Comments: k ElStk 466-6781 ❑ Lodi :369-3621 ElManteca 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 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO. INFO CASH +,EH13-24(REV.t i n 51 S / _ C 9.=, EH 1426 L