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SANIJOAQUIN COUNTY PUBLIC DALTR SERVICES , I ENVIRONMENTAL HELI �I ON 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 :PIRES 1 YEAR FROM DATE ISSUED PERMIT El I (Complete in Triplicate) Application is hereby made to than Joaquin County for a permit to construct and/or install the work herein described. This and Regulations of San application is made in compliance with San Joaquin county Ordinance No. 549 and 1862 and the Rules Joaquin County Public health Services. d 5 526 East h?o aada Lane citysl i,ot size/Acreage Job Address E owner's Name Dz. l om l3.ie.ee' �ehk.i. Address Phone �� C.Ca,zk Ooze, Inc, ,2024 E. Cha,,Ltea License No. 379__560 —Phone 462-7676 Contractor- �— AddressS viW 11 ervice Wel TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENTXOx DESTRUCTIODi 11 of Well xx SYSTEM REPAIR I_7 OTHER Q PUMP INSTALLATIONS DISPOSAL FLD.f 5 0 PROP. LINE _.Lj2! DISTANCE TO NEAREST: SEPTIC TANKf 77 5_— SEWER LINES PITS/SUMPS ��--- FOUNDATIONI AGRICULTURE WELL OTHER WELL INTENDED USE TYPE OF WELL PROBLEM CONSTRUCTION SPECIFICATIONS Dia, of W811 Casing 6 n n Industrial -0 Open Botiom El Manteca Dia. of Well Excavation e1 -.10 x{K1 }omesticlPrivate xEGavel Pack ❑ Tracy -'Type of Casing_ C f o Specifications !I Cl Delta Depth of Grout Seal �0 �_44ype of Grout—, I'l Public Cher I I Irrigation " Approx. Depth i I Eastern Surface 5eal'Installed by Fi P 7 7/L _ State Work Done p. Repair Work Done Type of Pumpl L Sealing Material.& Depth f ack Well Destruction xx� Well Diameter„� 6 -r Filler Material & Depth l� Depth TYPE OF.;SEPTIC WORK: NEW INSTALLATION I 1 REPAIRIADDITION i I DES TRUCTION I 1 availablerwit hin 200 feec stem 111sd d public sewer is Installation will serve; Residence I Commercial� Other ��-- --moi Number of living units: Number of bedrooms a Water table depth Character of soil to a depth of 3 feet: No. Compartments `SEPTIC TANK '� � 0 Type/Mfg ' Capacity Method of Disposal PKG. TREATMENT PLT. ❑ Property Line Distance to nearest: Well Foundation ` Total length/size LEACHING LINE 0 No. & Length of lines Pro rt Line FILTER-I3ED [] Distance to nearest: Well Foundation pe y f SEEPAGE PITS I 1 Depth Size Number SUMPS CI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ application and that the work will-15o done in accordance with San Joaquin county ordinances, stale laws, and I hereby certify that I have prepared this 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 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:"-*- i The applican" call I d s -o . Complete drawing on reverse side. Title:. Date: Signed X FOR- EPARTMENT USE ONLY f r _— �1 Area f i, • Data - -" Application Accepted by / q - ,+ = Date Pit o row Inspection by Date R qL Final Inspection'by . . QS "� Additional Comrr+ants: Applicant-i='_Return all copies to: San Joaquin County Public Heal h Services Environmental Health Permit/Services 445 N San Joaquin, P Box 2009, Stk., CA 95201 CK RECEIVED BY DATE PERMIT N0. FEE INF AMOUNT DUE AMOUNT REMITTED . EM13-14IREV.rlK51 rh LC? ,-0 '} EH 14-26 ��- / �