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DPLIC''lTTON SAN JOAQUIN COUNTY PUBLIC HEALTH SEFI!VICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468$420 P 0 BOX 2009, STOCKTON, C 9520 PERMIT EXPIRES 1 YEAR FROM D fE AU77 ' (Complete in Triplica efNV # Application is hereby made to San Joaquin County for a permit to construct a ?TI!!!0'MVM the work herein 1W9tribed. ;" " application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. obAdrlrpsc 632 S. El Dorado St. Cit, StocktonLot Size/Acreage Owner's Name Stockton plating Address Same as above Phone 948-1101 CASH CK RECEIVED BY 2825 E. Myrtle Contractor Spectrum Address , Stockton License No. 512268 Phone 465-8712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ( i DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK — SEWER LINES — DISPOSAL FLD. — PROP. LINE — FOUNUATIGN AGRICULTURE WELL CTHER lJELL — PITS/ SUNIPS — INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 10" — 12 Dia. of Well Casing rt R] Domestic/ Private Z Gravel Pack ❑ Tracy Type of Casing_ #40 PVC Specifications 0-02 Rt'rPP.17 ['I Public 11 Other :�`] Delta Depth of Grout Seal ap", 48 r Type of Grout cement/bent. I I Irrigation 7� tt Approx. Depth I I Eastern Surface Seal Installed by S1D2Ctrl]Il1 Repair Work Done 0 Type of Pump H. P. State Work Done _ 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 1 (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: etahla ft SEPTIC TANK ❑ Type/Mfg Capacity rhio016801 fitr,Tltd�hts PKG. TREATMENT PLT. ❑ Distance to nearest: Well Foundation PropAlirA z* LEACHING LINE ❑ No. &Length of lines TotalR"L��sizi--`. FILTER BED ❑ Distance to nearest: Well Foundation "ION SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O 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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as toibeeome 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 applicant mVst call 207 re fired ins ctions. Complete drawing on reverse side. Signed X Title: Ge010dist Date: 1-19-94 FOR DEPARTMENT USE ONLY Application Accepted by Date `"� Area / f Pit or Grout Inspection by Date Final Inspection by /-� Date 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 95S,Z.�I EH 13-24IREV. rinse EH 14.26 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH CK RECEIVED BY DATE PERMIT NO. GX�