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r APPLICATION FOR PERMIT .F SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL i ON AVE., STOCKTON, CA �' : y Telephone (209) 466-6781 v n V ii Z_g PERMIT EXPIRES TYEAR FROM DATE ISSUED 1 � (Complete in Triplicate} ENV�',0'�i u �t b t T� Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work her ,,�gfj�e f�T� I i made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and R2gltla3(on6 d'F•, �'i��quin Local Health District, Job Address 11900 N. Furry Rd. _._ City Lot size PM Owner's Name _SEAR CREEK WINERY Address 11900 N. Furry Rd. Phone 17754 N. Hwy. 88 Contfactor GOEHRING PUMP Address LOCkefOrd, CA License No.309031 Phone 727-5548 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR XX OTHER ❑ s DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS '' ' �'�NTENDED USE TYPE OF WELL PROBLEM AREA" CONSTRUCTION SPECIFICATIONS ' ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 0 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications Fl Public Cl Other F1 Delta Depth of Grout Seal Type of Grout _. 0 _ I I Irrigation _-Approx, Depth I I Eastern Surface Seal Installed by _ Repair Work Done iX] Type of Pump Tllrhi rip H.P. State Work Donerep_ak_r 40HP water-Iube0 Well Destruction ❑ Well Diameter Sealing Material Itop 50'1 turbine Depth Eiller.,Material_iBelow 50'1 _ TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I 1 DESTRUCTION I 1 (No septic system permitted if public sewer is available within 200 feetA Installation will serve: Residence_ Commercial Other €W? t Number of living units: Number of bedrooms r Character of soil to a depth of 3 feet: `~t Water table depth SEPTIC TANK ❑ Type/Mfg --Capacity No. Compartments •yCS I �a 7�" r PKG. TREATMENT PLT. ❑ �: Method of Disposal Distance to nearest: Well ' Foundation Property Line }w LEACHING LINE ❑ No. & Length of linesT Total length/size LJ FILTER BED Distance to nearest: Well Foundairon Property Line F" SEEPAGE PITS I I Depth Size _ Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ T_I hereTy a fy that i have prepared-this application and that the-work will-be done ia-'a'ccordanee-with San�Joaqumcounty`ordinances,state-laws;ar�7i- - rules and regulationsof the San aquin Local Health District. Home owner or licensed.gen' nature 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 n r as to become subject to workman's compensation laws of California."Contractor's hiring or sub-contracting signature certifies the following: " if at in the performance of the work for which this permit is issued, 1 shall employ persons subject to workman's compensa- tion laws of California The applicant must I f a ed inspections. Complete drawing on reverse side. f Signed X Title: $kpr. Date: 2/7191 61 f FOR DEPARTMENT USE ONLY 9 / Application Accepted by ,�"� Date �i� —5y Area Pit or Grout Inspection by Date Final Inspection by : .CA _ Date r l Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Bax 2009, Stk., CA 95201 FEE' INFO AMOUNT DUE AMDUNT REMITTED CASH �RECEIVED BY DATE PERMIT'N[O. +.EM 13-24 IREV.7 i h 51 175,.ZO-0If F Y tP .. �'^ �Q EH 14-26 1 �r� J l