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` �f11'1`11CAT ION IUH I'I HMII SAN JOACIIIIN LOCAL HEALTH DISTRICT • Ifolt I IIAr'I'_i0N AVL , STOCKTON, CA • 1 r•lehhnnn 1:olll MAI)6181 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ICompletr! in 'III 11''Itel 1-I,ly..•n L Heal Hnatn•fL.Plct Ire a n••rm•!to I nnanu't.tnr1 o• oatt If-work herPm described This apphcats•n is i rr,r�Un1nl.mcn Nn '-0!1 Inr vw.up•or Nn 1i.r;;Inr v.rl1 pur•g1.Ind the 110ps and Reylutahons of the San Jelayu•+ .7 iy �� r�.- f nr( 4�i 2'�'t�(nt Slra 1t�41�'<-- PM ---- '.� yf1 Phone! t, �J 7 h / G _�f4'C1cence Nc. Phonp�C:L��.� t;l,I f)l NEW WELL WELL REPLAC 1ENT DESTRUCTION i I PI IMP INSTALLATICN ' SYSTEM REPAIR i I OTHER 1-1 D,STANr.r "r-•l l•.T SFPTIr TANK _. ._ ._ ._ SEWER LINES __—_—__ DISPOSAL FLD._--- PROP. LINP fntINDATION -__ AGRICULTURE WELL ____ OTHER WELL _`iPITS,SUMPS tNTF 1JDI[ I'r TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Indn51mil Open Bottom t i Manteca -- D1a. of Well Excavation__ DTs.01 Well Casing —____-- Uonlestir 1'o..xl• Gravel Pack 1 Tracy Type o1 Casing--- ---. Specifications Plihhc OIMn 'Detha Depth o1 Garcon Seal --_—_— Type of Grout _ _.111-1141 Approx.Approx.Depth I 'Eastern Surface Seal Instew by --- nepav Work Done Type of Pump H P, - .--...—_-_--- State Work Done Well Destrurhnn WPI)Diameter Depth .____ Filter Material feelow SO') -- IyPI Ill. 1.11.11(:W,)Ilk Nt.W INSTALLATION RI PAIR i ADDITION 1 1 DESTRUCTION I I Mir septic SYS Permitted Mt A puc flewM is available within Installation will serve Re,odonee X C _ Other Number of bvo+q ands I ._ Number of N Character of s,.1 rn a depth of 3 feet: Waren labile depth ' 1 No Co SEPTIC TANK f I Type/Mfg CapacHyl�S of DX Compartments i PKG TREATMENT PI T i �` Method of npoul D)stande to n"I'eat: Weal FatrAstion�.d Property I— ZOO 50 LEACHING UNF No.R Length of tines Total bngthlsite—.a — FILTER BED Distance to resarest: Wee Foundation Property Line, 2— SEEPAGE PITS _— Depth _.. --.__ Sire SUMPS Distance to nearest WA .—_ Fnundatron .__..____ Property Line_ \, DISPOSAL PONDS I hereby cenify that I have,prepared this appircation and that the work will he done in accordance with San Joxlum county ordinances, state blas,and rules and requlahons of the San Joaquin local Health DAIncl Horne owner nr lrrnnsed agent's signature certifies the fod~np-. 'I certify that in the Performance of the wnrk for which this permt is issued.1 alga not employ any person,n.such manner as to twonee subs ect IT,workman's comoormatlon laws of CafdMMa"Contracto/s hiring or sub ContraCttnQ signature certifies the followmq I certif, .hat in the performance of the work for which this pe~is AscrOd.I shall employ PWSOM subfeCt to workman's comoensa lion laws of Cabforma.. The applicant mnst)l1 for of reqs rad 1 tion.COmpkNe drawing on reverse sw1e. k // �7, Signed X.-_._ .f.' .f?L.__ tv�2 ___ Title:_L�<< �----- — Date: FOR DEPARTMENT USE ONLY 1 1 ''f/ i� Area ! - Application Accepted fly — At—�u -- Date�_ - 21 Ph or Grout Inspection by Da a Final Inspection by c' 1 Date Additional Comments' ❑Stk X66-6�1 P Lodi 3693621 D 8?3 710/ ❑Tracy 835-521115- Return an copies to: Env roorrlental Health Permit/Services 1601 E. Harelton Ave., P.O. Box 2009.Stk_CA 1 FEE AMOUNT DUE AMOUNT 11f MITTED I CASH nECEMED By DATE PERMIT NO tH 13 2a t"IV • •• —/�� rH 14M