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SAN JOAQUIN LOCAL HEALTH DISTRICT - y 1601 E. HAZELTON AVE., STOCKTON, CA ReCF V�D - - Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISS ED �UG j 198; (Complete in Triplicate) V�a9NME#'TT�� .4mge5[t ed. This application.s Application is hereby made to the San Joaquin local Health District for a permit to construct and/or install I �]�L�� M,thn San Joaquin made in compliance with San Joaq+:in County Ordinance No.549 for sewage or No. 1RIi2 for well/pump and the Rules"eAQ 5, ,TI Local Health District. 521 North Cherokee Lane City Lodi Lot Size PM Job Address 1450 Harbor Boulevard RAMCON, Inc. Address Sacramento, 69 _ CA 951 Phone 372-7535 _ Owner's Name _— Trace Environmental Add, s 3084 Sunrise, Rancho CoL(kq) ,pIgCA 511740 ContractorPhone(916)638-804 TYPE OF WELL/PUMP. WELL 10 WELL REPLACEMENT 0 DESTRUCTION Cl l: ,-;-v, - PUMP 1 ST LATION 0 SYST SOREPAIR D OTHER ❑ (1� I(,�.,.��..``��11 e(( DISTANCE TO NEAREST: SEPTIC TANK NA _ SEWER LINES I AL FLD. NA PROP. LINE _NJA^ UNDATION ---AGRICULTURE WEL NA _ OTHER W LL3 0�0 PITS/SUMPS INTENDED USE TY F ELL PROBLEM AREA CONSTR CTION_SPECIFICATIONS 2n CI Industrial Open from Cl Manteca Dia. of W I Ertcava[ion qtr— — owof Well Casing PVC SCh 40 Specifications ❑ Domestic/Private IX Gra Pac L7 Tracy T f Ca- g , — Cement/5% beit( Ul Public F r moni r ( I Delta t of Gro eal 30 Type of Grout__ _ 1 I Irrigatip .__ ApMO%. Depth f EasternEasternt f ca Seal In lied by nite -- ! Repair Work Do I Type of Pump ------ H. ----- .l------ State Work Done_ \( Well Destruction 11 Well Diameter _._ - _._ S cling tefial (top - Depth _ _____ Fill aterial I w50') -- , TYPE OF SEPTIC WORK: N W INSTALLATION I !i FAIR ADDITIO I I DES T LICTION 1 I (No septic system permitted if public sewer is , available within 200 feet.) Installation will serve: Residence Comm rc, __ Other Number of livin nits: Num r of be ours __ S Character of s to a depth of 3 feet _ W r table depth SEPTIC TANK (1 Type/Mfg _ apacity o. Compartments PKG. TREATMEN PLT. I Method of Disposal r Dista a to nearest: ell _ Fo anon_ Property Line LEACHING LINE 11 o. ngth of lines .___._.__—___.. .__ --.— Total length/size _____ C ' FILTER BED Distance to Barest: Well - ___. .._._ Fn Property Line SEEPAGE PITS II Depth Number _ _. - _. .__._—._._. Number__ SUMPS 1 I Distance to nearest: Welt __._. Foundation Property Line __— DISPOSAL PONDS I l 1 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 Distract. 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." The applicant mus allrequi xf in p coons. .o ame drawing on reverse side. Signed x ____ Tide: Project Geologist Data: 8/3/88 l/Y FOR DEPARTMENT USE ONLY c �j Application Accepted by .��y �._�. V <:.,.ti �_,:;1� _— Date T �1� "X Area _ c- Pit or Grout Inspection by _.._ U_ Final Inspection by Date Additional Comments: — — ❑ Sik 466-6761 0 Lodi 369-3621 0 Manteca 823-7104 0 Tracy 835-6365 Applicant - Return all copies to: nvironmentat Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 F E gMOUNT DUE AMOUNT REMITTED CK RECEIVED BY GATE PERMIT NO. INFO CASH S� �/ �r� C . EH Ia-]x(REV .„xs� •l �� D��ISJ .M O ) jy 6� •:Z�I� EH 14M