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SAN JbAQUIN COUNTY PUBLIC HEALTH SMfVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 KM 313Y5 W-35c?O_f)1 P O BOX 2009, STOC%TON, CA 95201 -Mli_ftc S af-w I C-('S PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. ` Job Address 14000 S . Z_1arC-K- TbNG_ R0 City Lot Size/Acreage Owner's Name TP-1-1% SeO_VIICPS Address 2cDE96 $, Yh11'r�Tf�G.(� � Phone Contraclo �aCL.A&ss 2025 E. MYJZ- SP License No. ]1?_2-6e Phone1 �_' TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 1-1 DESTRUCTIO PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER r DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. R..o,t— (71L FOUNDATION AGRICULTURE WELL OTHER WELL -PgePSI� Aicr INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation -A--Lw-Lcff exj, [l Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ 1'I Public fl Other f1 Delta Depth of Grout Seal f I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by oeew Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material i Depth r Depth Filler Material i Depth /^uf tl. 43 L,L,Y TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 (No septic system permitted if public sewer isil Itc Lie available within 200 feet.) Installation will serve: Residence_ Commercial_ Other t2a6 .� Number of living units: _ Number of bedrooms Character of Will to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments ... PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 6 Length of lines Total length/size ` FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or subcontracting signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman'a compensa- tion laws of California." The applicant t call for all wired inspections. Complete drawing on reverse side. Signed r Title: _F._-N . aFi!-Od is-r Date: FOA DEPARTMENT USE ONLY r Application Accepted by Date - ^ 73 Area . Pit or Grout Inspection by Date Final Inspection by Dat iy Additional Comrnenta•!� ✓ � n Applicant - Return all copies to: San Joaquin County tic Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. ER I]-II(REV. /nal G' D ! `� Q/ re EH 141a J ^1