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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 41YENT P 0 BOX 2009, STOCKTON, CA 95201AxAVIONT PERMIT EXPIRES 1 YEAR FROM DATE ISSUED A"r, RLAO ED (Complete in Triplicate) r, 0 . 1992 Application is hereby made to San Joaquin County for a permit to construct and/or install theRTdifi tS rki, application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and t1 gNUJt'-0#4 Joaquin County Public Health Services. r r ^A ENV1R0%11VIL'1'1ISL Hic7AL ;1 i;IVC,S;u J Job Address 11255 N. Lower Sacramento Rd . city Lot Size/Acreage Owner's Name CARL BIANCHINT Address 1125 5 N. Lwr , Sac-rja=nto cbl,one P.O. Box 113 ContractorGoehring Pump _- __-Address Lockeford, CA 95237 License No,309031 Phone 727-5548 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION L7 Out of Service Well Ll PUMP INSTALLATION ❑ SYSTEM REPAIR ] OTHER ❑ Monitoring Well 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 ❑ Industrial ❑ Open Bottom ] Manteca Dra. of Well Excavation Dia. of Well asirig" ['I Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing_ Specifications Il Public Ci Other n Delta Depth of Grout Seal Type of Grout 11 Irrivation _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done Type of Pump Trtrhina H.P. 7 i State Work Done added 20 f pP. - Well Destruction ❑ Well Diameter Sealing Material & Depth Depth Filler Material & Depth- TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I IANo septic-system permitted it public sewer is availabie within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to s depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, a rules and regulations of the San Joaquin County Home owner or licensed ant's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall n employ any person in a manner as to become subject to workman's compensation laws of California." Contractor's hiring or Sub-contracting signatur certifies the followi 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 Calif The applicant f r required inspections. Complete drawing on reverse side. Signed Title: Up _ Date: 08/18/92 ;w/ FOR DEPARTMENT USE ONLY 7s Application Accepted by Date _X_ Area M?, Pit or Grout inspection by Date Final Inspection by Datey^ Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 INFO FEE AMOUNT DUE AM NT REMITTED � SH ECEIVED Y TE PERMIT'NO. . EH 13-24 TREY.i i m 5I /f EH 14.25