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Work plan faxed 'to l APPLICATION FOR PERMIT Elnore Ratliff SAN JOAQUIN LOCAL HEALTH DISTRICT 2-21-90 by Nolte { 1601 E. HAZEL T ON AVE., STOCKTON, CA Assoc . Stephen Kenning Telephone (209) 466-6781 4 if PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby 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 18846 N Miff 99 City Lodi Lot Size 55 4C PM Owner's Name Vfctor Fine Foods Address P .O . Box 147 Lodi Cal .95 24t2ne 209-368-5117 C Corning,Cal . 96021 Contracto,�iorth Valley Drill",,-,, Inc . P.O . Box 108 License No. 4.18834 Phone916-824-01 2 t TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER f Monitoring ! DISTANCE TO NEAREST: SEPTIC.TANK SEWER LINES DISPOSAL FLD. -PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS Ll INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS # 'CD.Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 11 ❑ Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing 8eh 40 PVC Specifications ("1 Public 1-1 Other ❑ Delta Depth of Grout Seal 10, Type of Grout Ne at c eI116?f} I I Irrigation 20t-Approx. Depth I i Eastern Surface Seal Installed by Cement _ Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 501 -� y __-,-Monitoring Depth Filler Material (Below 50') - 4 P TYPE OF SEPTIC WORK: NEW INSTALLATION.11 REPAIR/ADDITION I I DESTRUCTION I I (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 Characte of soil_to a depth of 3 feet: Water table depth SEPTiC TANK �+ D-4 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 1 _SEEPAGE PITS i,I Depth Size Number SUMPS L� Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ v ' 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 Di1trict. Home owner or licensed agent's signature certifies the following: "I certify that in the pe Wormance 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."Contractors hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, ).shall employ persons subject to workman's compensa- tion laws of California." i The appli t must call for allrequi n ctions. Complete drawing on rse side. / G Signed X Title: e:Dat2! b 0 _ DEP ENT USE ONLY Application Accepted by '# r DateArea Z Tky Pit or Grout Inspection by 47 A it Date Final Inspection by Date y Additional Comments: e-7-14 A Z EI Stk 466-6781 Lodi 369-3621 ❑ Manteca 823-7104 El Tracy 835-6385 �_. �, f c_ /1Cd T r_,& T Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 fe FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY GATE PERMIT'NO. )NFO Qj�fr, n +.EH 1 3.24(REV.i/n sI EH 14-28