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NAY- 5-95 FRI 14:b? KLEINhELDER HIK NU EU9946UUEI Y uElue • ApPLIC4'P70N +.+aa a- -- SAN JOAQUIN COUNTY PUBLIC BJ XTCES-"''�^"''"�`-'-•---^- SNVIBONMMTAL HEALTH DI I ,{�}{ 445 N SAN JOAQUIN, PRONE (20 -15420 -- P 0 BOX 2009, STOCKTON, CA 95204 $,F:N3p4I $BPIRBS 1 YEAR FROM PATE ISSN}UED (Complete in Triplicate) --- - Appileutlna to hereby nude to Sao .loocuia County for for a permit to construct ustilor izz"U the vork hernia described. This eppllcxtioo Is cattle la esaryllance with S" Joaquin County Ordinance No. 549 add 1862 " the Rule, and kegulatiehe or gam Joaquin County PublJc Health Ssrvleea. .Job Adds.-,. __'J ;��J „-;r�'_�:'!��=��...Avrz Crry Ld rOa Los Slse/Atreeye !iwr,ers Namer-'61': Gic•Lr Ll !"[r�rA Gr+ Address Phone �'y�__� ...<,.r�s,• ['f, fL, �d<z�.n., In Jr<s ) <vsc _ ' :Ionbac:a p�•�t'--+T �frr E?r_}•G�1_3_wAddressl+"i15 raFf �1�'�'tl� Sf- License No. 7 9�t7 Phone 4c7^_}�'jf � TYPE O_F_WELL/PUMP ~- NEW WE LC ❑ WELL REPLACEMENT fl DESTRUCTIONAOut or Service W;11' L.71 PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER ❑` Monitoring Well 0:5TANCi to NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION___..___ AGRICULTURE WELL OTHER WELL PITSfSUMPS INTENDED USE r TYPE_OF WELL PROSLEMAREA CONSTRUCTION SPECIFICATIONS Pot', alt:. U441S N ! i Indusinel IVA i;l Open Bottom 0 Manteca Die. of Well Excavation Die.of Well Casing _y' i i Dor.e"'Oprivate ,JEL Grave,Pack ❑Tncy Type of Casing,- F L'r�- Spe"licalioru .,- I i Pubth '1 Dow fl Oalta Depth of Grout Seal Type of Grout _ I I briueno!. ._•Apnron. Depth I 1 Eastern SuAace Seaf Installed by .• "Per woe Done U IypII of Pump ._..._... .._.— H.P. State Work Done Wall Detv,,upon U W64 Diameter _ _ __ Selling Material L Depth [Moth- 7 _ -_'J_1_ Filler Kstarisl i Depth +r`PE OF SEPTIC WORK:NEW INSTALLATION 1 1 REPAIR/ADDITION I 1 DESTRUCTION 1 I INo saprle system permiiled It public sewer Is available within 200 feat., tnstalla6un will io Ne• Residence_-- Commercial_ Other Number of living units' ,_„ Number of bodrooms Characm: of toil to a Onplh o(3 feet: _-_.__•...�..,. Water table depth SEPTIC TANK T_. Type/Mfg Capacily No. Compartments _- PKG, TREATMENT PLT �! Method of Disposal ., Distallco to nares- Well Foundation Property Lina LEACHING• LINE 0 No. 8 Length of linea _ Total length/size �..._..._.- FILTER beo 1.1 Distance to rearm: Well Foundation Propeny Line SEEPAGE PITS _'•._- I I Depth _ ,Site Number ~- SUMPS 1.1 Disiartce to nearest: Well Foundation Property Lina DISPOSAL PONDS _ Li hereby ca illy that i neve praparod chis application and that the work will be done in accordance with San Joaquin county ordinances, stale laws, and roles and rauulefiorss of the San Joaquin Cauncy More or w licensed agem'a signature certifies the following:"I certify that in the performance of the work for which this permit 13 issued, I shall not cmpiay any person In such manner as to becn rte subject to workman's compensation laws of California."Conlrattols hiring or sub-coniracting signature anifies the following: "I canny that in the perlormenca of the work for which this permit Is Issued,I shell employ persons srtbjecl to workman's compansa- dnn laws of California," Tree applicant m 31[,all Iw as required insD@ciions. Complete drawing on revenue side. 1 5fa lU • `! � Signed 7L.:.," �+,.._�-F^��Hr _,..`._..�. Tme: t T_�irs'7" Due. _V POR DEPARTMENT USE ONLY �. Application Accepted by ., Det'1(\�\ Area Prt or Grout IonpectWr+br _ -•_ -Bare �S S Final Inspection by - Data�2 Additional Gonxoanw: '1PPll!anc - netsrn ILLS -.ogles to: San Joaquin County Public Health 5ervieaa eoviroorsentel Health Permik/Services 440 N Sao Joaquin, P 0 Box 2008, Stkn, CA 85201 j FEf (' AUUUNT DUE AMOUNT REMITTED CEIVED BY GATE PERMIT No. INFO �� _ ,- H feeMa ry r,.,r V _ - Z Z�B3 5�-9�