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Il ANollRESNA Job #30003-4 <br /> D OQ < . , <br /> aNow, y - <br /> lIN3 <br /> C) > o <br /> 00 WX Top: <br /> Application is hereby made to the San Jo -� D <br /> erein described. This application is <br /> made in compliance with San Joaquin Cou a3 _ g 'O 4- nd Regulations of the San Joaquin <br /> Local Health District. - MMVol a C <br /> r <br /> 44 <br /> 0 <br /> Job Address 7906 North El Dora z3 k o _ _ °. , PM <br /> ARCO Products Co. grog I <br /> o' h <br /> Owner's Name ; _ cc n Phone <br /> o y 3 <br /> Not . <br /> nto <br /> coytractor Woodward Drilling :c Mo .ti q IVNl <br /> z ' ts C 1639 Phone 707 374-4300 <br /> PE OF WELUPUMP: VNITNIIII <br /> - --Ion . #J{ N El <br /> PUMP INST< s -n tIII <br /> Not fil <br /> R Monitoring and Vapor 11 <br /> DISTANCE TO NEAREST: SEPTIC TAD "e - n"z3 r3� 3 '?r� PROP. LINE <br /> FOUNDATICNo <br /> TAN S ? ol <br /> PITS / SUMPS ) <br /> INTENDED USE TYPE OF 4TO I T ,� Ar <br /> NNVVJg <br /> a V x <br /> e. <br /> ❑ Industrial ❑ Open Bon - iu" =�.�3a ' �Cq# I` TV <br /> long i �!ff�tart}„ _;� •; i; Dia. of Well Casing <br /> Vol <br /> ❑ Domestic/ Private ❑ Gravel Pal - of yam,a. . _ Specifications <br /> F1 Public IN Other F , 1 _ ype of Grout f[PD'F11M'111'P�r.FSRP t <br /> I I Irrigation _Approx" ': 5.: F "go �or TV al'il — .� s _ <br /> Repair Work Done ❑ Type of Pun ' <br /> Well Destruction ❑ Well Diamet logo <br /> 1"' 3Vo No , No INoll <br /> got <br /> ng.Other Depth _ c _ , <br /> TYPE OF SEPTIC WORK : NEW INSI �- 8 ?go <br /> n - _ .Q tem permitted if public sewer is <br /> _ To <br /> z n 200 feet. ) <br /> Installation will serve: Residence _ IN/ - - Nge .�7 = 1v <br /> Number of living units: Nur r� ; iyi VIAi^" <br /> Character of soil to a depth of 3 fee ; TxZ '? r t- able depth <br /> VL.SEPTIC TANK ❑ Type/ M - 1IIVIN <br /> — �1 ' L - No <br /> partments <br /> PKG. TREATMENT PLT. ❑ - Vol .[ 3 „ of Disposal - <br /> Distanc� } °404AL <br /> No <br /> Z <br /> LEACHING LINE ❑ No. & l - <br /> FILTER BED ClDistanc y4 � (- -� dP $ ---`r r d <br /> ei+ ) Nalld kd � _ _ �. lrws it :+6tldj �tj; l <br /> SEEPAGE PITS I I Depth aNgl Now No d1l.7 <br /> `> ; Vo - - <br /> SUMPS ❑ Distanr d1lool -- zt ,: - y�ie . a ion,-a; e r <br /> DISPOSAL PONDS ❑ vINN <br /> ?- <br /> I hereby certify that I have prepared - too uin county ordinances, state laws, and <br /> rules and regulations of the San Joe _ — +.. .11 <br /> �, ro - <br /> Home owner or licensed agent's sign - m [� r which this permit is issued, I shall not <br /> employ any person in such manner a: i- DO N` tor's hiring or sub-contracting signature <br /> certifies the following: "I certify that i - ,.G D �, ersons subject to workman's compensa- <br /> C" ootion laws of California. " - - 3 - P. <br /> 7C I <br /> The applicant m�y,?��?� 11 for-all re�q+uiir - s aIII C 2 I. go No <br /> Signed X ?- -� v-str , Ltle - rC- ' ' - Date: <br /> Eloise F . Cherven Rhe Project Geologist -FOR DEPARTMENT USE ONLY �•{/ <br /> - Application Accepted by Date Area / 3� <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> Additional Comments: <br /> ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 <br /> Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave. , P.O. Box 2009, Stk. , CA 95201 <br /> IFEE <br /> NFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. <br /> ♦. EH 13-24 IREV. 1 / 85) <br /> -f'y <br /> EH IC26 / <br />