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.� SAN .JIe..IaUIN COUNTY PUBLIC HEALTH SbrtfICES ENVIRONMENTAL HEALTH DIVISION _9 445 N SAN JOAQUIN, PHONE (209) '-- P 209)P O BOX 2009, STOCXTON, CA 35910g PERMIT EXPIRES 1 YEAR FROM DA Mk ^ ` (Complete in Triplicate Application is hereby made to San Joaquin County for a permit to construct and/or application is made in compliance with San Joaquin County Ordinance No. 549 and BNE and�he a110i W1111 neo an 11111 Joaquin County Public Health Services. �-. s. Job Address 20550 Kettleman Lanetwo City clic -/�- Owner's Name GUV, Andy Address 2n55n KPttlr, an Tanr Phone .. Contractor Parrish & Sons Address Box 1450, Stockton 952Ilcense No, 254343 Phone466-9607 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications FI Public ❑ Other 11 Delta Depth of Grout Seal Type of Grout I I Irrigation —.Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diam Sealing Material i Depth Filler Material i Depth TYPE OF SEPTIC W K: NEW INSTAL REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence YX Commercial_ Other Number of living units: 1 Number of bedrooms I Character of soil to a depth of 3 feet: Clay Water table depth - ' SEPTIC TANK XM Type/Mfg ConCYPtP Capacity 1200 No. Compartments 2 PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well 201 Foundation 51 Property Line 3991 LEACHING LINE (MX No. 6 Length of lines 1 - Sn I Total length/size 50' ' Y ' .� FILTER BED Cl Distance to nearest: 80'Well Foundation 20' Property Line " W SEEPAGE PITS IXX Depth 25' Size 36" Number 1 SUMPS LI Distance to nearest: well 140' Foundation 35Property Line 300' 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 sub-contracting 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's compensa- tion laws of California." The applicant} t call for all wired inspecti ns. Complete drawing on reverse side. ` Signed l/ Title: Vice President Date: 9-2-93 FOR DEPARTMENT USE ONLY M Application Accepted by Dat Pit or Grout Ins / (/ pection by Date Final Inspection Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services ��-f 4�• � I — L{a f � Environmental Joa Health Permit/Services A L-rt -1 445 N San Joaquin, P O Box 2009, Stkn, CA 952 ��/ � '�✓��(f6/ NFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVEDAY DATE PERMIT NO. EH 13-311REV.4.215 /� veal �3- l//1