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APPLCCA7:011 FOR PERMIT <br /> �. SAN jOAOUIN L^CAL HEATH C:STRICT <br /> 1501 E. 4AZ_171Av ;.YE., STOCt'^N, CA PERMIT NO. 1f— <br /> Tel e0hone <br /> f-Telephone `2M 466-673: '— <br /> DATE ISSUE? <br /> 7��Mi' rXP:RES _ !EAR :-Rom Ca-= i5SVED <br /> (Comolete in Triol:CataI <br /> Aoo'.icacion is ner-5;v ape w themac oaquin total Oistrict nor a permit to construct and/or install the work Herein <br /> cesc-ibed. This -oe �C3t'.Cn is .rt Compliance 41�:4 San Joaquin CCL^ty Ordinance No. 549 for sewage or No, 1866 410 r well/pump <br /> anG ^.e Rules ane ?s;ulations of •1e Sart Joaquin Local District. <br /> District. <br /> ..00 �Q4 r25s _ 7tel, � rs J`� division 'iame <br /> Owner's varve -Address ph On I* <br /> cntrac:or 'name7 4!_Aj License No. _�=Ly$ Phone <br /> TYPE OF JELL/PUMP .,IGRK: NEW WELL WELL RE?'.,ACEMENT DESTRUCTIONi� <br /> ?UMP INS-A:*AT!ON iJ SYSTE14 2EP.AIR OTHER <br /> DISTANCE TO NEAREST: SZPT:C T:.NK SEWER LINES DISPOSAL PLD. PROP. LINE <br /> FOUNDATION AGRICU4TURE WELL OTHER WELL PITS/SUMPS <br /> MNLLAL 7PE OF wELL PRO64EM AREA CONSTRUCTION SP£CIF?CATIONS <br /> 1_7 industrial J; Open 3ottom Manteca Dia. of Well Excavation <br /> L )Om@s,4c1Priv&te _—,ravel Pack - Trac/ Sia. of Well Casing <br /> i Puo l is 77 Other ui Del to <br /> V irrigation Aoprox. Eastern ype of Casing <br /> r Cathodic Protection Oertn specifications <br /> h Geophysical Depth of Grout Sea] <br /> Lj Other TYoe of Grout <br /> Surface Seal Installed by <br /> Repair Marx Done LI Type of oump H.P. State work Done <br /> well Destruction ;J well DiameterSealing material (top 50') <br /> 3eptn Filter material (Below 50') <br /> TYPE OF SEPTIC :CORK_ NEW :115TALLATION iJ REPAIR/ADOITION )ff (No septic tank or seepage vit permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve: Residence Commercial _ Other <br /> Number of living units: _� 4umber of bedrWM Lot size i <br /> Character of soil to a depth of 3 feet: A'Anger water table depth /s7 <br /> SEPTIC TANK Type/Mfg Capacity Yo. Comar meats <br /> PKG. TREATMENT PLT. Type/Mfg Capacity 'Method of Dlswsal <br /> Distance to nearest: well Foundation Property Line <br /> LEACHING LINE No. 3 Length of lines /— �17 Total length/size �A •C �d _- <br /> FILTER 9ED 17 Distance to nearest: 44 11 yo foundation �v --- Property Line S� <br /> SEEPAGE PiTS Depth A � Si2e Nurber / <br /> i <br /> SUMPSRd— Distance tv nearest: well / /r�i Foundation "o r ;'?vperty Line <br /> DISPOSAL PONOS <br /> i hereby _Artify that I :Save orsoared this application and that the work will be done in accordance with San Joaquin county <br /> ordinances, state laws, and rules and regulatlons of the San Joaquin Local Health District. <br /> Mom! owner or licensed agent's signature certifies the following: certify that in the per-fo►9Nnce of the work for which thiS <br /> permit is 'ssued. ! shall not employ any person in SLcn manner as t0 Jecome subject to wvrtmen§ cmiowsation laws of California." <br /> Contractor,i hiring 3r sup-contracainq sig ure cer-fries :he following: "1 certify that !n the performance of the work for which <br /> this pem t f sued. I snail �noioy per s subject to workman's compensation i8wS of altfornia.' <br /> 'he aoplic t _all for A:mions. wimp • ino n reverse side_ <br /> iigned Ti t1 e: Date: r L <br /> DEPARTMENT USE ONLY 166-6781 <br /> ADOIiCaLIOn ACCEDLed 7y �n � Area ©� f��Stk <br /> Addit'onal Comments: Edi 1,69-3621 <br /> Pit or Grout inspection ay Dace 'Manteca 823-7104 <br /> Final ;ns-jec_ion 5y i .G,y - Wit= iw-�'-rL AW 0 Tracy 335-6285 <br /> =moi':ant - 7ecarn ail --Jolts :a: Znvtr:norental lea:cn CaS :301 S. iez>tton ave., ".0. Sax n^.9. St;c., :A 95ZO1 <br /> . MO <br /> EE SASE 3U14T 3Ue 11OUNT 2EMIED R£r_c:YED 3Y DATE pETeMIT N0. <br /> INFO <br /> EH :3-2a 3E7. 19i?2 :0/82 :Oc <br /> _4-26 <br />