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1 APPLICATION I"011 PERMIT HECEIVED I� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E HAZEL TON AVF S1OCKSUN CA MAY 2 1 1990 Toleplione (2081 466 0781 ENVIRONMEN fAL. HEALTH PERMIT EXPIRES 1 YEAR FROM DATE ISSUI_D PES VI T/SERVICES (Compiete in Triplicate) Application is hereby made to the San Joaquin Local Health District tot a petnur to Carntruct and/or install the work herein deS[nbe4 This appucatto made in compliance with San luatluM Cnttnty Ord+ndncu No 549 lot sawdoo or N%. 1652 lot wewpuinp tout the Rutas and Rogutatrons of the San ivaouus Local Health Dlatdct -1 148 North El Dorado � City Stockton Lot Slits_ 250' X 2590M Job Address -�— -- - Wickland Pro ertles- Address 1763 Challenge Way _— Pnone (91 6) 921-110 0---- Owner s Name, __ �--- 1386 E --_Western ___ _-__- �-�•---- TYPE OP WELL/pUMP NEW WELL QQ WELL REPLACEMENT CJ DESTRUCTION f-1 PUMP INSTALLATION L' SYSTEM REPAIR Cl OTHER L7 DISTANCE TO NEAREST SEPTIC TANK __A&_ SEWER LINES _M'__ DISPOSAL FLD PROP LINE 75' Wh— �- - - FOUNDATION ___Z51__ AGRICULTURE WELL _WA-- OTHER WELL 30t PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEMS AREA CONSTRUCTION SPECIFICATIONS _ _ " L S Industrial � LI Open Bottom l Manteca Dia at lfifrtl e_,ree tat+eDia at Well Casing I I DomesticlPtrvate IN Gravel Pack i I Tracy Type of Cmmg 5C1 40 _ Specifications I Public 4 Other OG Delta Depth of Greut Seal _ N'_- Type of Grout I Irrlgattan 50'Approx Deplll r 1 Eastern Surflt a Snit Installed by - Repels Work done l 1 Type of Pump __ HP -- - Stale Work Done.. — C�J. Well Destruction i] Well Diameter Sealing Material Itop 50 1 1+�1V8 Sflil.) �Q' � - �- Depth _ Filter Mater at(Below 50) -- TYPE OF SEPTIC WORK NEW INSTALLATION I i REPAtReAPOITION I I DESTRUCTION I t INo septic system permitted It public sewer is %I available within 240 fasts I Installation will serioll Residence..-- Commercial - Other -- _ _-_ Number of Irving units -- Number of bedrooms __ Character CL sed to a depth of 3 teat — _ - - ------- - - _- --------Water table depth---- W -- SEPTIC TANK 1 i Type/Mfg --- - - - --------� C Ipactty -____ _- M Compartments _--� PKG TREATMENT PLT l 1 Method of Disposal Ot-tince to nedleSt Well _ _ Foundattor _ __-_ Property Line - --_ LEACHING LINE ~ -1 t No 8 Length of lines - _ -- -- _-- Total length/sue- FILTER BED t I Disiante to nearest Well _ Found inon _ _ __-- Property Line SEEPAGE PITS--_- _-i I Depth- -- - Stie _ T_- - _ Number -- ----- -- SUMPS k I Otstanta to nearest Well __ _ I.uunet Ilion — Plop..tY Line_ DISPOSAL PONDS i t 1 hereby certify that I have prepared this application and that tine work wtu be thine u1 aceotdan.e with San.loattuen county ordtnances stale laws avid rules and regulations of the San Joarlum Lueal h..- ' Home owner or licensed agent 5 Si$natufs C"I'tiftes the following l certtly that in the performance of trio won tM which this pamxt is issued t 5ltatl not employ any person In such manner as 10 become subject to workman s comc�ensar.on laws of Cautocnia Contractor s filling or sub•contractutg s+gnature certifies the following I cerlttY that in the performance of the work fol which this pelma is Issued t shalt employ persons subtect to workman s corttper'sa tion lawn of California ' The applicant must r am mplete drawing en level"side Signed X„-- Title Presidmt. #A037—_ Date -HW-J$ -JCQQL - FOR DEPARTMENT USE ONLY Appltcal ccepled by - _— _ ____ --- Dace --- - -- Araa Pit or Grout Inspection by _--- _--__ Date __ - F nal tnsp4coon by— - Dato Additional Comments - Li Slk 466 6781 0 Lodi 369 3621 L;Manteca 823 7104 Tracy 835 6385 Applicant Return,ill copies to Environmental Hearth Pefmitl8ervicss 1401 E Haraiton Ave P O Box 1009 Stk CA 46201 - - FEE AMOUNT DUE AMQUNT REMtT7EQ CASH RECEIVED aY DATE PEfiMil NO INFO l -