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r <br /> A?rLICF7i'.v -c: x READY FOR <br /> S., INSPECTION <br /> 1601 E. H+EEL70', AVE., STOCtilO':. C4 rERuIT 140.7 _ <br /> Trleo"ne (209) 466-6781 . <br /> DATE ISSUED <br /> P=R?!IT E*PiRE�; I YEAR FROm DATE ISSOED <br /> (ComDlete in Triplicate) <br /> Application is hereby made to the San Joaquin Local Healtb District for a Permit to construct 6md!or install the Mork herein <br /> described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. L862 for well/pump <br /> and the Rules and Regulations Of the San Joaquin Local Health District. <br /> t, Job Address 13683 N. Hvy. 88 Subdivision Name <br /> Owner's flame F. Frd= SOA Dalt Address 13683 N. Huey._ $8. Lo��^Phone <br /> ' <br /> Contractor's Name Goehfina in�_ PuLicense No. 309031 phone 727 --5-5AE -- <br /> TYPE OF YELL PUMP WORK: NEW WELL WELL REPLACEMENT E DESTRUCTION CJ <br /> } *. PUMP INSTALLATION)0 SYSTEM REPAIR l_d OTHER <br /> t- - DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE <br /> - FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> Fir INTENDED USE TYPE OF WELL PROBLEM AREA CGNSTRUCTIDN SPECIricAnclis <br /> ❑Industrial pen Bottom ❑Manteca Dia. of Well Excavation 14" <br /> w 7tg Domeitic/Private Gravel Pack Tray Ofa. of Well Casing <br /> .._ 10" <br /> ❑Public Othe• EJDelta Type of Casing <br /> Ittigatian Appror. Eastern Specifications <br /> Cathodic Protection ,00 <br /> " -- ❑ Depth Depth of Grou" Seat $O f t. <br /> {�Geophysical Type of Grout 1 <br /> "❑tither' Surface Seal Installed by GOehr ina. PUmp 04 <br /> Repair V.ark Done❑ Type of Pump SU -H.P. ��State Work Done Iy <br /> ' Well Oestruction❑ Well Diameter _ oti ' _ Sealing Material (top 50') <br /> . Depth 290 f t. Filler Material (Below 501 7 <br /> TYPE Of SEPTIC WORK: NEW INSTALLATION[1 REPAIR/ADDITION 1_.1 (No septic tank or seepage pit permitted if public sewer is <br /> available wit'rin 200 feet.) <br /> Installation will serve: Residence Commercial — Other <br /> NurAw of living units: Number of bedrooms Lot size <br /> 5 Character Of sail to a depth of 1 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No, Compartments <br /> P <br /> . . <br /> " KG. TREATMENT PLT. Type/Mfg Capacity Method of Disposal <br /> SEWAGE SYSTEMDistance to nearest: Well .Foundation Property Line <br /> OESTRUCTION ❑ ' <br /> rc"LEACHING 1111E (J iO. 6 Length of lines Total length/size <br /> " FILTER BED ❑ Distance to nearest: Well foundation Property Line <br /> SEEPAGE PITS ❑ Depth Size N,mber <br /> SLMPS 1J Distance to nearest: Well foundation Property Line <br /> z- <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin county <br /> ordinances. state laws, and rules and regulations of the San Joaquin Local Health District. <br /> r Hone owner or licensed is signature Certifies the following: "T certify that in the performance of the wnrk for which this <br /> permit is issued, not employ any person in such manner as to become suNect to workman 9 compensation laws.of California.' <br /> Contractor's sub-contracting signature certifies the following: "I certify that in the performance of the work for which <br /> this permit i 5 11 employ persons subject to workman's compensation laws of California." <br /> The applica t r all required inspections. Complete drawing on reverse side. <br /> Signed k Title: Hkpr• Date: 12/6/86 <br /> TMENT ONLYr� <br /> 'Application Accepted Dy Area F] Stk 456-6781 <br /> Addlticnal•Coi"ti. �ad1 369-7621 <br /> Pit or Grout Inspecti4, t*tal <br /> —� Date / 0 Manteca 827-110" <br /> final Inspection by _ Oato 0 Tracy 075-6305 <br /> Applicant - Return 411 copieHealth Permit/Services 160! ze ton Ave.. P.O. top 2009' Stk„ CA 95201 <br /> i REvtlttD —RECEIYEO DATE PEo"i, <br /> FEF RASE AglN- DU <br /> __C MOUNT <br /> IO N0•�' <br /> 4s Y$� <br /> 10!A2 r1ol) <br /> EH 13.44 KEW. IO/H2 <br /> r i4.76 <br />