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APPLICATION <br /> SAN JOA UIN <br /> copy <br /> Q CO[1i�TY PUBLIC H13ALT8 SERVICES <br /> ENVIRONK TAL HEALTH .DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-342,1V " <br /> P O BOX 2009, STOCKTON, CA 95201 , ,. <br /> PERMIT RLS °1 YEAR FROM DATE Isaftb MAR 2 2 1994 t; <br /> (Complete in Triplicate) <br /> Application is hereby made to San Joaquin County fora permit to construct and/or. at.l< aR This <br /> application is made in eonpand/or." <br /> at 41t�h &a Joaquin County Ordinance No., and 1862 and <br /> Joaquin County Public Health Services. San <br /> E <br /> Job Address6"6 14U <br /> t Si se/Acrea6e ----- <br /> West r �.n- ay. j t' <br /> Owner's Name Address Phone ------- <br /> .0 fiew f`j-e'nt a 3241 Fitzgerald Rd. , 02 <br /> Contract c0-Adit(Turner ExAddress Rancho Cordova 9574Zicense No. 662720 Phone( 916 852- 454 <br /> TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT n DESTRUCTION Cl Out of Service:Well <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR C1 OTHER O Moaitoring Well <br /> DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER LINES 301 DISPOSAL FLD. NZAPROP. LINE 5 1 <br /> FOUNDA-TION 1 1 AGRICULTURE WELL NSA OTHER WELL NSA PITS/SUMPS N/A <br /> INTENDED USE TYPE OF WELL PRO8L,EMAREA , CONSTRUCTION SPECIFICATIONS <br /> n Industrial O Opal Bottom O Manteca Dia. of Well Excavation Dia. of Woo Casing 2" <br /> CX Domestic/Private 1 Gravel Pack O Tracy Type of Casing_ PVC SCh. 40 Specifications <br /> I'l Public 1:1-Other 1-100114 Depth of Grout Seal 41 ' Type of(,rouportlanCl ge er. <br /> I I Irrigation Approx. Depth IN Eastern SuAace seal Installed by f lush grey Well cover <br /> Repair Work Done U Type of Pump H.P. State Work Done _ <br /> Wog Destruction O Woo Diameter Sealing MaterW_i Depth bentonite . 41-431 <br /> Depth Tiller Material L Depth monterev -sand #3, 43-60' <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAiP/ADDITION 1 I DESTRUCTION 1 1 INo septic system permitted it cell Wer is <br /> available within 200 1 <br /> Installation Residence— Commercial_ Other <br /> Number of living units: Number of bedrooms' <br /> Character of soil to a depth of 3 Water table depth <br /> SEPTIC TANK O Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. O Method of Disposal <br /> Distance to nearest: ell scion Property Line <br /> LEACHING LINE Cl �41,nce <br /> h of lines Tots /size <br /> FILTER BED wresr. Weq Founaatwn Property a�. <br /> SEEPAGE I I Depth Size Numbs <br /> S Ll Distance to neaast: Well Foundation Property Line <br /> DISPOSAL PONDS O <br /> I hereby certify that I haw prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin County - <br /> Home owner or licensed agent's signature Certifies the following: "t certify that in the peeformancvof the work for which this permit is issued. I shall not <br /> employ any person in such n%snner as to become subject to workman's compensation laws of California."Contractor's hiring or sub-contracting signature <br /> certifies the following:"I certify that in the performance of the work for which this permit is issued. 1 shell employ persons subject to workmen's comperna- <br /> tion laws of California." <br /> The appacaa required ' Complete drawing on reverse side. <br /> Signed Title. Project Manager Date: 3-22-94 <br /> FOR D Is RTMENT USE ONLY <br /> Application Accepted by Date Ates <br /> Pit or(trout Inspection by Data Final Inspection by Date <br /> Additional Comments: <br /> Applicant - Return all copies to: San Joaquin County Public Health Services r Environmental Health Permit/Services <br /> 443 N San Joaquin, P O Box 2009, Stkn, CA 952Tj510__L4 <br /> FEE AMOUNT OUE AMOUNT REMITTED K RECEIVED By DATE P6141"T'NO. <br /> INFO CASH <br /> . ill13.24I11Ev.1iass r '.0� t/T/�oo f /� :y • <br /> EH 1431 ---iii! ` "i <br />