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rr '� APPLICATION FOR PERMIT SY JOAQUIN COUNTY PUBLIC HEALTH ahRVICSS ZN V I RONUENTAL HEALTE DIVISION i P 0 BOX zoos, STOCKTON,. CA 9520 b j (209) 468-3447 1!Za.A1T & 1R55l YEAR ?RQM DATE _ISSUED. (Complete in Triplicate) t Application is hereby aade•to San Joaquin County for & per-alt"i,,o construct and/or natal.) the vork herein described. This application is made in =plianee with San Joaquin County Ordinance No. 549 and 1$62 and the Rules Lod Reauistions of San r Joaquin County Public 'Health Services. " Job Address 781 Swift W v Ck,'Stoeicton Lot size/Acreage At i r-Q* Owner's Name Swift Transporta Inn Address -7-q LI;wift WnU _ _ Phone 943-7476 a CA 95691 Contractor WESTEX Address P.O. Box 1664, W. Sac_License No. 552198 Phone 935-373-1 TYPE OF WEL;IPUMP� NEW WELL ❑ WELL A£PLACEMENT DESTRUCTION 0 out of Service well C1 {{ PUMP INSTALLAT10N C SYSTEM AEPAIA ❑ OTHER ::Soit pri we31 r " i(HUorin .s CISTANCE TD NEAREST: SEPTIC TANK w•m SEWER LINESA/7c, DISPOSAL FLO. ]L}--- PROP. LfNpi _ FOUNDATION ) ,� _ AGAICULTURE WELL 41,:� OTHER WELL nZ•� PITSISUMPS J INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS f. IInnoustrtai G Open Bottom G Manteca Dia. of Well Excavation 1� Dia. of Weil Casing e olmestic/Private EY-16'nvei Pack G Tracy �,�1 Type of Casing_ l/11 ?U C- - --- Specifications �J ❑ P„otic I:1 Other 12-64,1111 5u"'” Death of Grout Seal / Type of Grout C Innjatlon •-.-Aoprox. Depth G Eastern Surfici Soul Installyd by Repair Work Done f3 Type of Pump ,(V r4 H.P. State Work Done Welt Destruction ❑ Weil Diameter u: Sealing Aater:al i Dept)': Wa-"r—o r'F t�L1Jfr/ _Tb f� SLY Depth k. Tiller Anterial i Depth �JbArc.C7nsTr�(s¢aa`T r1 ro s-,z*Ac.c --as�w is /P ro -?,Tl "J TYPE OF SEPTIC WORK: NEW INS TA_LLATION L REPAIRIAOOITtON 0 DESTRUCTION F-� iNo seorie system permitted if public sewer is available-within 4-00 too(.) _ Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of sail to a depth of 1 teat: Water table Oeoth SEPTIC TANK ❑ `Typo/mfg, Capacity No. Compartments PKG. TREATMENT PLT.0 Method of Cispasel d Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 3 Length of lines Total length/size FILTER BEO Cl .Distance to nearest: Well Foundation .Property Line t SEEPAGE PITS 11 Depth Size Number ' SUMPS Ll Distance to nearest: We" Foundation Property Lina i -DISPOSAL PONDS ❑ � k I hereby certify that; have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the Sen Joaquin Cg+.utty Home owner at 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 employ any person in such manner as to become subject to workman's compensation taws of Catifamia."Contractor's hiring or subcontracting signature candies the following: "I certify that in the performance of The work for which this permit is isaued, I shall employ persons subject to workman's campsnsa� tion laws of California. The applicant must cafl for alar uired ' siections. Complete drawing on reverse side. a a Signed Title: Geologist/Agent for Date: Z `j Westex ... F4iiDWI SE ONLY f5 33 t w�,•. ` Appfiutian Accepted by y = pate a t6t11 Pit or Grout inspection by Date �� ,F—vion by pate Additional Comments: Appllcan: - Return all ccplae to: SAN JOAQUIN COUNTY PUBLIC HEAL—,Y SERVICES ENVIRONt1ENTAL HEALTH DIVISION PERMIT/SERVICES G 445 H SAN JOAQUIH, P 0 BOX 2009, STOCKTON., CA 93201FEE INFO AMOUNT OUE AMOUNT AZ MrTTEO t:SH i AECciVE0 BY DATE PEFIZIT NO. SCJ[��Jry [/�J� 7[]� 7t ."r O �L V