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(No septic system permitted if public sewer is available within 200 feet.) i I 1 I -6 i / \" .. , Water table depth ; . 11.4 r) 1,,. I SEPTIC TANK t CI Type/Mfg Capadity .-- -4-'7.-4' A‘.•••No..- Cd;npartment;''`I PKG. TREATMENT ,PLT. 0 1 - ./...„, Mellihd .of Disposal i \ 1, ; ..1 " .-t-li,ri.' 4, i 1 .--- -114 Distance to nearest: Well ' Foundation J.' rropery ,Line . t'-'\:,.; 1 .,-. i k - ' vi;‘....,. / LEACHING LINE At No. & Length of lines Tot /I leng lt,..size c Y- ) - FILTER BED 0 Distance to nearest: -VA:41 Foundatkm .7-'preir:ierty Line SEEPAGE PITS Ll Depth, Size q.x-----742-•• urber . - ; • i .t. I SUMPS IX, Distance tf5 nearest: Well /...)0_4--;Foundatio '-'l Property Line,45'':0 19— ,...0_,. i _, _ . DISPOSAL PONDS Li I %.A.' ',..1 4 i 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 Local Health District. f, 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 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- •• . i tion laws of California." The applicant must all requir pections. Complete drawing on re erse sid Signed Title: FOR DEPARTMENT USE ONLY INTENDED USE Industrial Domestic/Private Public D Irrigation Repair Work Done Well Destruction TYPE OF SEPTIC WORK: NEW INSTALLATION E REPAIR/ADDITION Installation will serve: Residence Y. Commercial _ Other Number of living units: Number of b redr ms Character of soil to a depth of 3 feet: C- Application Accepted by Pit or Grout Inspection by _Approx. Depth'i LJ Eastern El Type of Pump . - H.P. 0 Well Diameter Depth Open Bottom Gravel Pack r-PRO13LEM ARE LI Manteca El Tracy?. Other ODelta A TYPE OF WELL f / A Date k tate 41/oriVone 4 X I e' - Searing Material (top 501 A Material; C JA4STRUCTION PEC)6 Dia. of Well Excavatior0 Tye of Casing x. Depth of Grout Seal Typeoi Grout Su4ace Seal Installed by 5 Final Inspection by DESTRLiclOti t i t t ( - Date Area .06 CATIO'NS:. Y".. Dia. of Well -Cas,ing Specifications' 1. Date: A e — , Dat'e APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA 'Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is heieby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 3 91 /2i5Cier /11/e- CityESC*16, Lot Size-3 RC • PM Contractor a—CV ki TYPE OF WELL/PUMP: NEW PUMP INSTALLA DISTANCE TO NEAREST: SEPTIC TANK FOUNDATION Address WELL 0 WELL REPLACEMENT '0 i DESTRUCTION Li TION 0 SYSTEM REPAIlk L=3 t '6.1-tiqt o SEWER LINES 1 i asPOSAL FLD. (--- PROP. LINE .k AGRICULTURE WELL i OTHER WELL "1S/SUMPS Owner's Name 14 ea Phone gZ g-377.:.5- — IP( .(MkreNo. Pho 7- \ N. Additional Comments: E Stk 466-6781 El Lodi 369-3621 0 Manteca 823-7104 0 Tracy 835-6385 Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 « EH 13-24 MEV, 1/ t; EH 14-28 FEE AMOUNT DUE AMOUNT REMITTED CK ii CASH RECEIVED BY - DATE PERMIT' NO. INFO # --76.i2S2..' eleduic . 3---(7 r-i- ;a2(