ARCHIVED REPORTS XR0006463 - Laserfiche WebLink

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'� �� r,1,fv ItlstitE++lrJ tttl ,tt ''i .yl ! t! ITI'i7lSlt;T dri ltii}i I Ilrti! i ItrfJ ..` t , I(h P If)fV Ln i „ I14,q 1 41 3 I'f:11MIT hXPIRI SI1YLIAR VRQMDATE ISSUED (CUf111r14-11; Ill 1 ril,Ill.010 L�t r 1 H . i L i fE t?Tt t*rt,i} �L+ DLrebed This app iee]ron is Application r5 ftereby malt t8 the San Jne urn LO+nt Hedtth Dt,lrlct Ii + d[enc ler lis �r,n,fnrtt fjti �1 OV3 made len COrtiplldr+Cu with San J+1d1IUln CuuQty Or I+riJ"LU 140 '-4J fur _,.w Mi s or riv lt+4l ttir w,.il/X,*p and �y�rbk �et}uldt+Ons of this San Joaquin Local Health Dosuict Job Address t' f?3VT Y_ ZO' t+ t Ext DDL9j a3 fznn Pw1f1C _ City_St�m List Sire Tv A PM Owner s Ndmi. - A WlCkland 011 (b. AddrL— 1765 C)allenge 1�Y, Sa=-dT �" ento Phone (916) 921-1100 - ---- - ----- Conira[Iol V�s�t len Cho- --- 1� E- r St- �1l 513857 (915? 662-4541 r Aid less ---- � �L Icertse f!o � Phone TYPE OF WELL,PUMP- NLW WELL X, WELL REPLACEMENT T i DESTRUCTION Ll PUMP INSTALLATION i ' SYSTEM REPAIR Ll OTHER & a*17tatc3r testi r DISTANCE TO NEAREST SEPTIC TANK --N/A SE1hER LINES __75' DISPOSAL FLD IV/A PROP LINE 2 -T _ �FOUNOATION - 10fl'- AGRICULTURE %VELL--- Z -_ OTHER WELLPITS/SUMPS -LZ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Ll Industrial I ` Open Bullunt I , MdrilLLd Did of W,II Eecdvdtion " Dia of Well Casing D Domestic/Private k Gravel Peek 11 rrdcy Type of Cdsing RC Specifications 11 Public I Other }." DLItd Depth of Grout Seal 30' Type of Grout !nt 03TMt +5 I ) Imgdtion 65'Alrliroii De.plh Easton, St ild,-e Seal Installed by R�Stpam Repair Work Done 1 ) Type of Pump __ y _ __ H P Stdte Work Done _ Well Destruction 1I Well Diameter _�� _ �_ Sedl,nq f30at Cffnmt + 5s b3lbOritG #3 1=tee � Depth --65'-- - Fill�r frtaltreal IdeowIPQ-1 30 TYPE OF SEPTIC WORK NEW INSTAI IATION t 1 NLPAM PAODITION i ' FASTM 1CT10N I I (No septic system permitted if public sewer is available within 200 feet ! Installation will serve Residence — Commercial — Butt r Number of living units Number of bedioums _ __ Character of Buil to a depth of 3 feet Water table depth SEPTIC TANK L1 Type/Mfg ______ _ _ _ _ _ __ CaE1d�+ty ___ - No Compartments PKG TREATMENT PCT I 1 Method of Disposal Drstdnee to nearest Wi 11 Fr,orrrtatson _ Pruperty Line _ LEACHING LINE- No & Length of lines _ _ TOtdl Iungth/site_ FILTER PED l I Distance to nearest WL8 F(w if ition _ __— Property Line _ SEEPAGE PITS I I Depth __ _ __ S1 u _ flurnlrer — _— SUMPS 1 DrstditLd to ncdresl �i u )r..,n,foruin Property Line - DISPOSAL PONDS I i hereby certify that I hdve pri pared this applitdtion and rh r1 'Li wink w 11 L, ,lur- tri .0L6rJrddnte wrtf+ San Joaquin county ordinances state laws, and rules and regulations of the Sdn JoagUln LULaf He,411h Dtmrrn r Home owner or licensed ayeril s sio(iaturu curtihus this fuR„v.r,41 I r.e,rt,ly that Ili ittu purfurrtiuiCe of the work for which this perk-rut Is issued I shall not employ any purson len 51.101 mdnner ds to beLUlne su111041 to wujMin it, I ,Ur«fgsnl,tions Taws of Cdlifolnid CpntldClur s hiring or sutHcontracting signature certifies the futlowing I certify Itidt in 1110 purforrl+ditCe ul tliu w(1rA lur V%11101 It,,,,uvrmil is Ib,uud I shall umpluy persons sub}ecl to woikman s tom nsa tion laws of Cal lornia SP i tOAQUIN LOCAL HEALTH DIST RIC The applicant must tel r al b r d t t+p unit Autu drawnitE un revurse sletu ENViRO\1A�„LN�TAI- HEALTH DWISION Ti11e __ Presz Lt SPF-C;Al ERMf-C/g9 Signed X -- -- - - - FOR DEPARTMENT USE ONLY Appki Accepted by yam_ _ — - Datu Area Pri or Grout Inspection by —_ _— Dale _ _ _ Firidt Inspu+nan by Date Additional Comments -- -- - - - - _ -- - ----- 0 Stk 466 6781 0 Lodi 369 3621 tJ Manteca 823 1167 1 I Tracy r1J5 6385 Applicant Return all copies ick Envtrorlmentdl Hoelth PefrTnt/Service] ib01 E Fldruhun Atu P 0 Bax 2009 Stk CA 95241 . FEE AMOUNT DUE AMOUNT ktMlTftU alCLIVED Ely DAII PERM 47 NO INFO - ---- — - - -- . EN 13 24 1REV lows, EN 14 m r `tn