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w APPLICATION FOR PtRMI:T RECEIVED AAP( 40AOUIN LOCAL HEALTH DISTRICT MAY 2 1 1990 1601 L HA?k1 [ON AVE , S1 OC K rON CA Telephone (2091 466 67111 ENVIRONMENTAL HEALTH PERMIT EXPIRES 1 YEAR FROM [SATE ISSUED PERMIT/SERVICES (Complete in Triplicate! — Application is hereby made to the San Joaquin Local Health District for a permit to consirrict andlor install the work herein described TMs appli.at-nn is made or)cornplydnce with San J(14quin Cou,ily Ordinance No 549 for sewdge or No lf:IQ for wellrpump ane the Rulas and Requlationa of the Siv%Juaomil LoLat Health District Job Address __1 448 North El Dorado _ --— City Stockton Lot Size 250' X 2500M Owners Name _w'Ckland Properties__ _ Address 1765 Challenge Water_ —��_- Phone 1[91 fi) 921-1101) Conliactar Western Geo-En :Ln ddtess 1386 E. E12tirer, Wim, CALicense No 513857 ph P (W!v) 662 1 TYPE OP WELL/PUMP- NEW WELL X WELL REPLACEMENT C7 DESTRUCTION E, PUMP INSTALLATION 11 SYSTEM REPAIR (1 OTHER ❑ DISTANCE TO NEAREST SEPTIC TANK _ N/A SEWER LINES 50' _ DISPOSAL FLD i�APROP LINE r - -FOUNDATION 25' AGRICULTURE WELL -WA-- OTHER WFLL 30' _ PITSISUrtP_S INTENDED USE TYPE OF WELL PROBI EM AREA CONSTRUCTION SPECIFICATIONS_ _ Ll Industrial (J Open Bottom ( l Manteca— Dia of Well Exedvatton 36u Dia of Well Casing " C 1 Domesticf Private 0 Gravel Pack I I Tracy Type of Casing PVC PZh AQSl,ecdtwtbns I I PUblic (1 Other 04 Delta Depth of Grout Seal r _tk1Q Typo of Grout 1 I litigation 51r Approx Depth I I Eastern Suilace Seal installed by _ Repair Work Done U Type of Pump —_� H P State Work Dona T Well Destruction 0 Well Diameter _ _ Sealing Material(top 50 Qr 1 Ful- (Qeat1 N3ftve bb43.) Depth_ Filler Material (Below 50 1 TYPE Of- SEPTIC WORK NEW INSTALLATION r I REPAIRIADEATION I I DESTRUCTION I I Wo septic sy�torn permitted if public sewer is available within 200 ftset } Installation will serve Residence — Comn er-al _ Utter Number of living units Number of W-WOOms Character of soil to a depth of 3 feat - - _ _ _ Water table depth SEPTIC TANK 1-1 TypelM€g _ _ _ Capacity -�_ _ No Comportm4nts PKG TREATMENT PLT I 1 Method of Disposal Distance to nearest Well _ Foundation _ _ Properly Line _ LEACHING LINE i I No $ Length of Ernes _ _ -_ Tutai lengthl sue FILTER BED t I Distance to nearest %.fell _ Foundation -� Property Line SEEPAGE PITS I I Depth __ Y _...Sire Y _ _- -_ r _ Number -- SUMPS 1 I Diutant,e to nearest Wall __ Foundation _ _— Property Line DISPOSAL PONDS i I _ 1 hereby certify that I have prepared this=application and that the work will be none in di.Lordance with San Joaquin county ordinances state laws and rules and regulations of the San Joaquin Local Health District Hartle owner or licensed agent a ti nature conities the following I cartity that in the pert rrmance of the work for which this Permit is issued 13hatl not employ any person in such manner as to become sublect to workman s compensation taws of California Contractors hiring os sub-contracting signa ure certifies the following I certify that in the parformance of the worts for which this permit is issued I shall employ persons sublect to workman s contpensa tion Iaws of California rhe applicant mus fa"e r Complete drawing on reverse side Signed X _ __ Title $>�t: �._fxxilcr v f Q3?_ C►ate May_1_6,, 1990 --- IL FOR DEPARTMENT USE ONLY Aaphcati n Accepted by � __- __ _ _ _ Date -_ Area Pit or Grout Inspection by _ Da a ___ �— Final Inspection by __—_ Date Additional Comments _ - r-) 8t 466 6781 CI Lodi 369-3621 zJ Manteca 823 7104 - t i Tracy 835 6385 —�— Applicant Return all copies to Environmental Health Permit/Servtces lb01 E Harelmn Ave P O Box 7009 Stk CA 95201 0*0 AMOUNT DUE AMOUNT REMtTTEO CASW RECkiVED 6Y DATE PERMIT NO l . EH 1324IREV i wai CH 14 26