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SAN JOAQUIN COVINTY PL-81,110 UALTH SERVICES EN V I R01TM 1,2,TAir HEALTH DIVISION 445 N :SAN JOAQUI,\t, PHONE '209)468-3420 P 0 BOX 2009, STOCXTON, CA 95201 PERMIT EXPIRES J, YEAR FROM DAa'E ISS 131 (Complete in Triplicate:) ;cation is hereby made to San Joaquin County for a permit to Construct and/or install the work herein described. !^atior, is made in compliance with can Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations Of ,--Ir. County- Public Health Services. �!E' N � '� _ ;�;r,l i;' -} Lot Size/Ac cage City 1 64 -- Address _�.---- ---- Phor.e T(131r1 Address _?_.��_ _L�-Oaf) ,&.ate- 'License No. 360-(S� Phone F WILL/PUMP: NEW WELL :h WELL REPLACEMENT (^ DESTRUCTION L� 0•ut of Service We.l'. PUMP INSTALLATION SYSTEM REPAIR �; OTHER G Monitoring We::. CF TO NEAREST: SEPTIC TANK rJQ� - SEWER LINES j�10k _-DISPOSAL FLO.---- ' -PROP. LINE S7d'r FOUNDATION I AGRICULTURE- WELL _ OTHER WELL-900f_ PITS/SUMPS — %DED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPEC1riCATONS ❑ Open Bottom 0 Manteca Dia. of Wel; Excavation Dia. of Walt Casing t ^,nbsrc r Private R` ,Gravel Pack O Tracy Type of Casing- ne Specifications - ------ u, Cl Other Fl Delta Depth of Grout Sea! ='- 7`" ` /Typo of Grout_ Ir +(jaaion .�s�2trApfxox. Dap!h t I Eastern Sur-face Saul Instal;6d by-_— _ -- c,))D:r Work Oone Li Type or Pump �U hl`✓1 H.P. r_ Stara Work Done Ili Destruction 0 Well Diameter S•ealinS Material & Depth Depth _ Fillcr Aster ial lh Depth )r- SEPTIC WORK: NEW INSTALLATION 1 i REPAIR/ADD!TION I I DESTRUCTION I I (No septic'system permitted if public sewur .s avai!abte within 230 feat.) ins,,0ation will serve: Residence __ Commercial _ Other Nurnber of living units: Number of bedrooms _- Character of soil to a depth of 3 feet: -- Water table dopa a SEP'.'i� TANK 0 Typrt/Mfg -- _-- Capacity No, Comparlmrints ^'Q TPiEATMENT PLT, 0 A/ethod of Disposal Distance to nearest: Well Founeacon Property Lino EACfi NG LINE LI No. Er Length of lines _ Total iendthisize `::!.Tail eEO ❑ Distance to nearest: Well _- Foundation Propeny Lir,.°. SIkf."-AGi: Pi T S 11 Depth _-� Sire .--------_-�--- Number _ -__-- SL"I LI Diviinca to nowast: We'i _-_ oundatio:; - Pro;, r y Lira+ v! >AL PONDS O i—r! .^art 4y that have prepared tnis application and that the work will be done in accordance with San Joaquin county ordinances, state lar.s nd rogulations of the San Joaquin County ownar or ficensad agent's signature eerUfies the following; "i certify that in she per-formance of the work for which this parmtt i:; issued, i am;:-,I<''.y person in such manner as to become subject to workman's compbnsaoor, laws of California." Contractor'; hiring or sub-contracting signator ccmfoes the following: "I certify that in the performance of the work for which this perroit is issued, I shall employ pe,r3ons subject to workman's compaln.;a Non laws of Cafifornia." sho applicant mast tali for all reecuired inspections. Co/mplete, on reverse side. 1 Smvnud X ''!' {, '' / t-/k -�L' s`�•;:o: -- -- f�r� r✓i —- Dace: +� 1 - �' FOR gEPARTMENT USE ONLY on Accepted by ----`-_ �T r Date ;,rout,iawction by_i - cd c,,s; J /',� Final Inspecticin be :I Comments: / •�f I •s+nt - Heturn all copies to. Sar. Joaquin County Pifolic Health Services Environmental Health Permit/Services 'l 445 N San Joaquin, P O Sox 2009, Stkn, CA 95201 FEE AMOUNT DUE C A,►A01�Nfi REMITTED . / t� FNECEIVEO ,Y ATE PERMIT NO. INFO t . EN t2+iFEV.rrn 5r�t'1-' Err as x w" — - — --- - j- Qj. -`�2�¢-j��-.'�.+ ;�a<r�}:� N.PoIs,+ti4�ILefJ ,' .. ._.. ,., •:tel