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SAN J('-QUIN COUNTY PUBLIC HEALTH SFXIVICES <br /> `,,lV I RON]WENTAL HEALTH D I V I S I C <br /> 445 N SAN JOAQUIN, PHONE (209)469"-"3420 <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application is hereby made,to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. <br /> Job Address 29099 South McArthur Road c;ty Traces Lot Size/Acreage <br /> owner•sName Teichert Agg_regateS Address 29099 S. McArthur, Tracy_ Phone <br /> Contractor Spectrum Exp . InCAddress 2825 E. Myrtle Str License No. 512268 Phone 465-8712 <br /> TYPE OF WELL/PUMP: NEW WELL 0 WELL REPLACEMENT n DESTRUCTION a Out of Service Well 0 <br /> PUMP INSTALLATION C SYSTEM REPAIR 0 OTHER G Idonitoring Well 0 <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE <br /> OTHER WELL PITS/SUMPS _ <br /> Post-it®Fax Note 7671 Date f #of l- TION SP£CIFICA 1'rUNS uQU� <br /> pages <br /> 0I Excavation Dia. of Well Casing <br /> n To ?��. From j l(� ` sing SL.L.. 4n PUL Specifications <br /> I.I Co./Dept. ��� n Co. �G ,, S - ti J <br /> rout Seal Type of Grout <br /> I 1 Phone# Phone# I if <br /> G �-3 ' ri Installed by OR�,ci2e G A2&4T- <br /> Re Fax# Ct,j(/_ Fax# O 7 State Work Done_ <br /> W 1 i Depth <br /> Depth <br /> TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 (No septic system ed if public sewer is <br /> availa in 200 feet.) <br /> Installation will serve. Residence_ Commercial_ Other <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth o set: Water table depth <br /> SEPTIC TANK O Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. 0 Method of Disposal <br /> Distance to est: Well Foundation Property Line <br /> LEACHING LINE 0 & Length of lines Total length/size <br /> FILTER BED Distance to nearest: Well Foundation roperty Line <br /> SEEPAGE PIT'r, I I Depth Sue Number <br /> SUMPS LI Distance to nearest: Well Foundation Property Line <br /> _DISPOSAL PONDS 0 _ <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance withr San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin County <br /> 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 <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> certifies ' g: "1 certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion I of Califo its." <br /> The pi cant must all for all r uire ins o . omplete drawing on reverse side. <br /> Signed Title: Manager Date: 10-6-94 <br /> �r ! FOR DEPARTMENT USE ONLY (0� -� <br /> Application Accepted by v ` Oats Area <br /> Pit or Grout Inspection byoats a t� Final Inspection by Dace l/ <br /> `r• <br /> Additional Comments: t✓ n <br /> Applicant - Return all c ies to: San Joaquin County Public Health Services <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED CK a RECEIVED 13Y DATE PERMIT'NO. <br /> INFO J(G�� �CASH <br /> . EH 13.24 IREV.I/AS) �L� 7 10 `��:/ •s <br /> EM 14.26 <br />