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ENV I RON1dKNTgt-AEALTH DIVISION 1601 WAZELTONPHONE (209)4R't-3420 BOR 2009, STOCKTON, CA 950 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby mnde.to Sae Joaquin County for a permit to construct and/or install thq work herein described. This application Is ends, in coe,pliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 1715 East Alpine Avenue City Stockton Lot Size/Acreage Ernest Oneto ( 209 )463-9967 Owner's Name Wilma Garibaldi Address 1715 East Al p;ne Avenue Phon4 209 464-081 7 Contracts * Address License No. phone TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT n DESTRUCTION O Out of Service Well ❑ PUMP INSTALLATION ] SYSTEM REPAIR ❑ OTHER ❑ Monitors SoiiforWeln Zi l DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS I` ❑ Industrial O Open Bottom O Manteca Dia. of Well Excavation Dia. of Well Casing 171 Domestic/Private O Gravel Pack O Tracy Type of Casing_ Specifications * I'1 Public I:1 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx, Depth I I Eastern Surface Soul Installed by Repair Work Done 0 T p p Type of Pum H.P. Stats Wort Done _ Well Destruction O Well Diameter Sealing Material a Depth Depth Filler Material i Depth 1 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo seplic system permitted it public sJis 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 leer: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line (� LEACHING LINE t. t Total lengthhize FILTER BED 'Distance to nos'r : Well Foundation Property Line SEEPAGE PITS 1 I RI ^ _Size Number SUMPS LI Distani;* to nearest: Wall Foundation Property Line DISPOSAL PONDS I hereby cenBy that I have �Q�pga,r ' f9FWh�ptL�n and that the work will be done in accordance with San Joaquin county ordinances, state Laws, and rules and regulations of the Sari loagwn"�owrtjr Home owner or licensed agent's signature unifies the following: "I cenify 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 workmen'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 compansa. tan laws of California." The applicant mustI� r all to e. /QY��red inspectio f. Complete drawing on reverse sid (,l Signed a 1 rJ r' Title: �1 � Date: V AtOg DEP ENT USE ONLY Application Accepted by Date` O ` �j A s�� f Pit or Grout Inspection by Da //1� Final Inspection Date —7CC1 Additional Comments: * refer to "Groundwater Assessment Report, Kear q-RPF" for details Applicant - Return all copies to: Son Joaquin County Public Health Services, Itovironmental Health Persalt/Services 1601 E. Haselton Ave., P 0 Boz 2009, Stockton, CA 95201 INFO AMOUNT DUE AMOUNT REMITTED I CASH RECEIVED BY DATE PERM17'NO. FN I4.M My.i/ear t� l� / W 71,: I �/ �/ V0,