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APPLICATION FOR PERMIT E � . SAN JOAQUIN LOCAL HEALTH DISTRICT E I Vs E Di 1601 E HAZELTON AVE , STOCKTON CA MAY 2 1 1919 Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUEDENVIRON MENTAL HEALFH WY^ - (Complete In Triplicate) PERMIT/SERV!CVES Application is hereby made to the San Joaquin local Health Disinct for a permit to construct and/m install the work herein described Thus ap-hcation is made in compliance with San Jnaqum County Ordinance No 549lor sewage or No 1462 for well/pump and the Rules and Regulations of the San Joaquin Local Health District Job Address 1448 North EI Dorado City Stocktan Lot Size,_._. 250' X 2504M Owners Name Wickland Pro ernes Address 1765 Challenge Way Phone (916) 921-1'100 Contractor Western Gea-Enq neeePrA&Iress 1386 E. Lgemer, 4b1d, CA_License No 513857 Phone (916) 6652-4E 41 TYPE OF WELL/PUMP NEW WELL E29 WELL REPLACEMENT 0 DESTRUCTION 0 PUMP INSTALLATION L7 SYSTEM REPAIR 0 OTHER C] DISTANCE TO NEAREST SEPTIC TANK _ N/A__ SEWER LINES 50' DISPOSAL FLD W_ PROP LINE 75' FOUNDATION 25' AGRICULTURE WELL ,�— OTHER WELL 30' PITSISUMPS NL INTENDED USE TYPE OF WELL rAWLEM AREA CONSTRUCTION SPECIFICATIONS Ll Industrial L] Open Bottom L; Manteca Dia of Well Excavation 361' Dia o1 Well Casing 4" CI Domestic/Private CM Gravel Pack Ll Tracy Type of Casing F'lrlr &► 40 Specifications I I Public f-1 Other DQ Delta Depth of Grout Seal None Type of Grouter I I Irrigation SW Apprax Depth l 1 Eastern Surface Soul Installed by Repair Work Done L7 Type of Pump H P State Work Done Well Destruction 0 Well Diameter Sealing Material (top 50} 10' Cert -yI;zt d Soil E!j-U (CLem N�Ve Soil) Depth Filler Material(Below 501 - TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIWADDITION I I DESTRUCTION i I (No septic system permitted if public sewer is available within 200 feet I Installation will serve Residence_ Commercial Other_ Number of living units Number of bedrooms _ Character of soil to a depth of 3 feet Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No Compartments PKG TREATMENT PLT Cl Method of Disposal Distance to nearest Well Foundation Property Line LEACHING LINE Cl No & Length of lines __ Total length/sae FILTER BED 0 Distance to nearest Welt Foundation Property Line SEEPAGE PITS I I Depth _ Size Number r SUMPS I I Distance to nearest Well _ Foundation Property Line DISPOSAL PONDS 0 I hereby certify that I have prepared this application and that the work witi be done in accordance with San Joaquin county ordinances state laws and rules and regulations of the San Joaquin Local Health Di3tnct Home owner or licensed agent's signature certifies the following I certify that in the performance of the work for which this petrmt is issued i shag not employ any person in such manner as to become subject to workman s compensation laws of California Contractor's hiring or sub-contracting signature certifies the following I certify that in the pnrtarmance of the work for which this permit is issued 1 shall employ persons subject to workman s compensa tion laws of California The applicant must c>t. all u s C mplate drawing on reverse side Signed X Title IoncaaidMt _ Qmlap--%t #1037 Date _ aU 18. 1 _ "OR DEPARTMENT USE ONLY Applicati Accepted by __ _ _ _— _ Date Area Pit or Grout Inspection by __ Data � _- Final Inspection by Data Additional Comments C1 Stk 466 6791 0 Lodi 369 3521 LJ Manteca 823 7104 ^CJ Tracv 835-6385 Applicant Return all copies to Environmental Health Porrnit/Services 1601 E Hazolton Ave P 0 Box 2(09 Stk CA 9661 FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT No �t INFO f • EH 1324 FpEV i w�: EH 14 20