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SAN JOAQUIN WCAL HEALTH DISTRICT 1601 E. HiAZELTUN AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) ADpl,cabon is hereby made to the Sar Joaquin Lc.-cal Health District for a permit to construct and/or install the work herein de.critred.This sp`lication a made it compliance with Se„Joaquin County Ordinance No.549 for sewage or No. 1862 for welUpur p and the Ruk;sand Regulations of the San Joaqu;ri Local Health District. : � a5,_1 J•+b Address &4/C111 Site _(� 2.!5z, J PM Owner's Name �1�li _� � i C�---�✓ !i_� a_! Phone Contractor -,A6C6-_S- -v Address _ cJ(f Qt ' e+t�-+f License No. .1�Y�YJ"Phpne �j JDA TYPE OF WELL)PUMP: NEW WELL L) WELL REPLACEMENT L; DESTRUCTION 0 PUMP INSTALLATION L', SYSTEM REPAIR [1 OTHER 0 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES — DISPOSAL FLD-_ PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL_ PITSISUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS : Industrial C' Open Bottom Manteca Dia.of Weil Excavation_ Oia.of Wall Casing Domestic.Private F Gravel Pack i' Tracy Type of Casing _ Spis-4icaticirn Public i- Other i Delta Depth of Grout Seal Type of Grout Irrigation g ---Approx. Depth i' Eastern Surface Seal Installed by Repair Work Done Type of Pump H.P. State Work Done_ Well Destruction 7 Well Diameter _. Sealing Material Itop 501 _ f Depth __ Filler Materialelow50'1 TYPE OF SEPTIC WORK: NEW INSTALLATION i ' RE /ADDITION i (No septic system permitted if public wirier is C/ availahte within 20D feet.] Installation will serve: Residence — CommercialOther Number Of living units: Number of bedrooms i Character of soil to a depth of 3 feet: _ _ _.—Water table depth SEPTIC TANK Type/Mfg _ Capacity-` _ No. Compartments r PKG. TREATMENT PLT. Method of Disposal Distance to nearest: Well Found ion Pr6perty Line LEACH IN LINE No. 8 Length 1 Ill,, r' / f A o es _ �I e,�aLlengih�size -5-7 44TER BED Distance to nearest: Well _ Found ion �7QY-property Line _ SEFP%GE PITS Depth v _�$i, _ ___. Number SUMPS Distance to nearest: Well Fo�u�/ndation Property Lina DlsPojAL PONDS C. �'' T-',Ch_rC/-, k I� ��t�.dCr- l�n..f I hetehv certify that I have prepared this application and that the work will be donne In accordance with San Joaquin county ordinances,state law3,and rules and regulations of the San Joaquin Local Health Dist•ict. Home owner or licensed agent's signature tortures the following: "I certify that in the periwWrtiCe Of the work for which this permit is issued, I shall not employ any person in such manner as to become itubtect to workman's Compensation laws of California."Contractor's hiring or sub-contracting signature +. certifies the following: "I certify that in the pariOrmant,e of the work for which this permit is issued,I&hall employ persons subiect to workman's cornpenea- tion laws of California" The applicant must telt for rad in"ctions Completlr drnwing on reverse side. C 7�ed X f Ct'�_Y••la/�_x�- Titla• - Date: FOR DEPARTMENT USE ONLY Apph title Accepted by 7 o�t�nspettiort�y " J DataCi inspection_1 �'/1_1 Final I by at; r --T� Additional Comments: — Stk 4666781 ,' Lodi 369-3621 i Mantecri 823.7104 I Tracy 895-6386 Applicant • Return all copies to: Environmental Health PwmitlSerrlces 1601 E. Hazelton Ave., P,O. Box 2003, Stk., CA 96MI FEE AMOUNT DUE AMOUNT REMITTED INFO K a RECEIVED By DATE26 pEAMIT'NO. `7 c"0 ' �1(� U . rr.it 7.rnrE� F L/ ar i. .;ry