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APPLICATION. SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 PO BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application ie hereby made.to San Joaquin County for a permit to construct and/or.install the work herein described. This applipation ie made in conpliance with San Joaquin County Ordinance No. 549 and. 1862 and the Rules and Regulations of San Joaquin County Public Health Services. 1'6042 E. Baker Lane Linden r,nt size/Acreaae Owner's NameC` & A Lagomarsino Address _1 6042 E. Baker, Linden Phone _ ContractPurviance DrilIes,I)Wress . P.O. Box 64., Lindenpcg& No. 377923 Phone 887 - TYPE OF WELL/PUMP: NEW WELL}$_l WELL REPLACEMENT 11 DESTRUCTION ❑ Out of Service Well ❑ _ PUMP INSTALLATION -17 SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well U DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial Open Bottom Cl Manteca Dia: of Well Excavation--- -^' "_ Dia. of Well Casing 12 -3 4_. fa Domestic/ Private Cl Gravel Pack ❑ Tracy Type of,Casing_....___"StPe1 ` Specifications Il Public. 1.1 Ote( 1-1 Delta Depth ,of. Grout Seal 2501 a' Type of Grout V51: Irrigation rJ Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump 111AD—_— H.P. 40 •" •.r+ State Work Done Well Destruction.. ?_ O .Well Diameter Sealing i t,, ha- i, Depth Depth _ Filler Material-& Depth _ TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION L I ,DESTRUCTION -1 I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence ___ -Commercial T Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: _ _ Water table depth _ SEPTIC TANK. ❑ Type/Mfg Capacity_ -_ No. Compartments PKG. TREATMENT PLT. ❑ _ Method of Disposal _ -:Distance to nearest: Well _ Foundation Property Line ' LEACHING LINE 0 "No. & Length of lines _ _ A �. Total length/size—,-- FILTER BED CI Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size _— Number _._. SUMPS l:1 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I 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 San Joaquin County Home owner or licensed agent's signature certifies the following: "I'certity 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 laws of California." Contractor's hiring or sub -contracting signature certifies the following: "I certify that in the performance of the .work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of California." The plicant m t call ,f req 're insPections. Complete drawing on reverse side. Signed rGl/ f! ---� Title: _ (,C),rp Cz-c 'ei- a -r r _ Date: _ 9.1249 2 Application Accepted by F- Pit or GrowNspection by Additional Comments: Applicant - Return all copies to; EH 13-24 IHEV. lies EH 11.26 FOR DEPARTMENT USE ONLY Date.-� ^a_:,— Area Date /�/p Final Inspeqiojn by _~7 — Data AiMl, L�( Et GLe L�F1l.��JI'Lc.�- z7i Dd In ." _e aw"el, o. T San Joaquin County Public. Health Services O_ Environmental Health Permit/Sorvioee 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 n ,r INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED 8V DATE PERMIT' NO. 1UN2— 9 C 3 6717 g ^p A n ,r