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APPLICATION SAN JOAQUIN COUNTY PUBLIC' HEALTH SERPI,CE �?rQ y�� FNVIBONMENTAL HEALTH DIVISION Nr :- 445 N SAN JOAQUIN, PHONE (209)4683420 P O BOX 2009, STOC3:TON, CA 95201, ` Ppy 2 3 to93 -REUT =PZRiE YEAR FROM DATE IS'. SAN JO;�QUIy COClNTY (Cotaaleze is Triplica>:e) +'1rnONr�9 NEALrHSc4V�CcS ENTAL : kE.4LT;-!plVfSION Agpllcazion is heretrf cede to Sea JoaQn1II Caurtty :or a per•: to Co=r--uct ,tad/or laatall the,vcrk h,erela described. T: appL*Ca;:CII ilei 77adC .'31 C't:i�tlyaIICr vlt h 31= JCaquia Czn 7 Ord'—ace No. 549 and 1862 and thr iltJ t�ef �� ArgulaLtoIIa Or So ( Joagt is C4ual7 i?nh11c lesl:h Serv%cea. .f i jos Accrete 503 WEST LARCH ROAD City TRACY t.ac S;ze/Acreage _ .S 11.CRFC 343 SAHSOME STREET, SUITE 900 Owner's Name HELLER FIRST CAP T PAddreis —SAN FPAN o4j n . .-'o I'.LS�...C�, Peon. C 7 1;7 r PO BOX 2664 CanEractt>rPOwERCORE 'SO'IL SA_ MpCINF�eF� E. ANTI�lr1-!= -rA 9�53� License No.6 ?I 15` : P'►tane I�r]�-177R TYPE OF wELLIPUMP, NEW WELL 1= WELL REPLACEMENT © DESTRUCTION 0 Out or 9ervicr Vel` I PUMP INSTALLATION ❑ SYSTEM REPAIR C OTHER ❑ monitO'IZS ue1 DISTANCE TO NEAREST: SEPTIC TANK SEINER LINES DISPOSAL Fi.D. PROP. UNE FOUNDATION- AGRICULTURE WELL' . QTH ER-WELL"'�:. ,PITS/SUMPS' INTENOEi] U58 TYPE OF WELL PRO13LEM AREA CONSTRUCTION SPECIFICATIONS L 'I lndustr4al ❑ Open damn ❑ Manteca Dia. of Wed Excavation ii bis. of won is sting 0 0anumiclPrivate ❑ Grav i Pads ❑ Tracy Type of Casings ^" 'Specifications fI Public n Other n Delta Death of Grout Seal Type of Gr I 1 t"iWeion AVOtOx. Depth t 1 Eastern SudwA Seal tnstalled by i Repair Wort Done U Type of Pump H,P; State Wont Don* f Won Oaxtrucaon ❑ Well Diameter -AeaL=.'t8 mazer%" A Depah Death P=er riser-'.s1 i Depth �r+. TYPE OF SEPTIC WORK- NEW INSTALLATION t I REPA1R1ADDITION I I OESTRUCTION 1 I INC"Otte Mtarn;Pamtrtted it public tarter is i avaflat"withinl2W leet.l Installation win save: Residence,. Commercial_ Other Number of living units: Number of bedrooms�— Chwacw of sod to a depth of 3 feet: Wates tat" depth SEPTIC TANK. C3Type/M}q CsEsacfty No., ,r •�� PKG. TREATMENT PLT.C3ii8at?,od 4I Disposal D' anp to neem WOO' Foundation Property Lira LEACHING LINE ❑ No. ly Length of tinea Total Iertgthlsize iF FILTER BED ❑ Oil"mm to near*= Wed Founaation�� Property Line — s SEEPAGE PITS 1.1 Depth Sipe Numbs SUMPS U O'tstarci to rtearesa Wep Foundation��_ ��RY'Luria DISPOSAL PONDS C3 �. . 1 ho+eby cmTY that I have prepared this appfi=wM and that the wont will be done in accordance with San MISS and requtam m of the San Joaquin C==vT Joaquin'eounw ordinances. state taws. Hattie owner or Germed patters sfgnatum cauftes the fOkwwW- "1 tames th that in e performance of the mmsc for wftich thq i @nu*l►any person in wch-@nrwr as to became Aub permit is issued,'I shaft cw&iies the fo � Ma m+Mortrkfor nsch Mi aOw laws at Cd.i 3 nia." �r+traetarrs hiring or zuereontmaartq signs tlowir+ certify that i�tete pertomssrsca of tree woAt for wEtiCh oris permit is i..uad, l snarl snnptoy peragna subject to warkman'a cdrnpu ' tion taws of Gsuformia.' The appGcanc G for all Complete " � ,. drawing Ari re/v'erse side. : S-wad �.,�-�r'`'Q?� /�" Title: u �a.�aa i Date: I1-17- 3 FOR OEPAATMENT USE ONLY Apdication Accepted br Date ZD 3 Araf Pi!or Grout Inspection by Date i� F,nat 11oft-jan by ' Date Addf kvW Cornnsantz Applicant - Return all copies to: Sas JoagutA County 9rtdlia Ilealtls Services $a►iroameat.al 8ealtb Per2it/3ervlcex 443 a San Joaquin. 0 Box zoos, Stets, CA 43201 11 FF-z .�MOUWT CtJE AlvlOUreT REArETTED O wFG REC�IVEfl dY Cw'TE K, PEAMft NC. Or,:.:.tan. S, I St 4�� //: �� '1 q "Pag