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eb SAN JOAQUIN COUNTY PUBLIC REALTH OERv*CSS ENVIHONYENTAl. BHALTU BIVISIOA' 1601 E. HA7.ELTON AVE. , PHONE (200466,4420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM BATH ISSUER (Complete 1n Triplicate) Applfeation la hereby sada to Sen Jasuin County for a Mrslt to conetrurt aorl/or Isamu the work hecetn described. This application Is mile in compliance with San Joaquin county Ordinance No. 54 and 1867 and the Rule. and PeSulatlons of ben JOaguln County PublLc Realth Sacvlce.. Job Address ) c:�• .f -_— Cnv:G'G:��:IG�tilt SS ee/AereaKq j' - t I t . _ Syr � .. '�Ii one. Owes,.NFr,,M((rA ��./ � udrnn - Cool,ar la_Lll��2 _Address ____-.______.--L'cense No. __Phone YYPCl-CCWELLIPUMP. NEW WELL C] WE REPLACEMENT f 1 DESTRUCTION Cl Out of Service Well Boni tocing Well C7 PUMP INSTALLATION ❑ SYSTEM REPAIR Ct OTHER O DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES __ DISPOSAL FLD.__ PROP. LINE _- FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS El led.svul ❑Open 6111 m ❑Manteca Ola.of Wen E•ove'on Ow.of Well Casip f!Domestic/Prlyale ❑G•lleW Peck ❑Tracy Type of Coruna. Speada:e,ans I Public I Otar fl Delta Depth of C'nut Seel Type.1 Grout - I I Inlgatio-t —Aprm.. OePth I I Eastern Surface Seal Irwtalled by__ Repair Work Dons L) TYPE of Pump ILP. -- Stars Werk Done_ Welt Destruction ❑ Well Diteeter Sealing material A Depth Depth filler Material A Depth TYPE OF SEPTIC WORK: NEW INSTALLATION P1 REPAIRIADDITION I I DESTIIUCTION I I oal3septic �nµsystem fa'Osd d PnbNe awel n Imulbtipn will arvs: Rspden<a Commercial_ Dther_ Number Of Oyinp units:L_ Number of bedrooms,_-- Ems Character of soh to a depth of 3 1a1- -Water tible depth l\ f SEPTIC TANK M Type/Mfo aLl.iroi by e LaIl4rc.."/.+9 Capacity Z21) No.ComWmnnts l-� I 1^ PKC.TREATMENT PLT.❑ / Method of(Dippoul tit' 1 kyr OlWance to merest: Well Intl Foundation 1Q__ Property Line T LEACHING LINE OR No.6 Length of firs..�- 1 41/ �7Total length/size T? Foundationred Property Lines FILTER BED ❑ Distance to nnareaL' WWI maim �_ ti SEEPAGE PITS I Depth 8 Bin x Nuber IT, SUMPS Diatoms to oar.ec WWI fV6_._ Foundation 96' Property Line S___ -, t DISPOSAL PONOS ❑ 1 hereby tanify the,I nave prepared ten application and mat Ion work will W done in accordancewith San Joaquin con oldmanen, Web Iowa.and rules and rept bllons of to San Joaquin County Homs awns,Or licensed agent',signature renins the IOEowbg:"I unify major the pemermino of ma work for which this Mnmt's issued,I shall not employ any person In such rmnner as to become subject to workmMs compensation laws of California"Contractors hiring or sub-contracting signature canines he foh w,ng:"I csnifY that in Ina performance of to work for which this parent Is issued,I sail employ persons subject to workman,a cOmpenaa ,Ion laws of California." The applicant/q�ust esY//�pf 1 t ad bapecuons. Complete drswmg on nowners side. --f '• � signed x_ /1 /if.N L. at/vim/%_.ct/�� Tids: Q )ILyP /L Dere: _/„-9-s _ .� �� FQR DEPARTMENT USE ONLY t Application Accepted DV �J►kL�.wr�^.-r •�t' Date Arora Z( j� 1 Pit or Grout Inspection by Date Final Inspection b Date )� Additional Comments - a'� Applicant - Return all copies tat Sm a Joquin County Put Se Health ;R Servlen, 1'ayirorsonul Ree1t11 PernitStockton. -- 431y{py;'' 1601 Z. Battalion Ave.. P 0 BOK 2009. Seoctton, Co 952D1 FEE AMOUNT DUE AMOUNT PFMITTED CA51faE DATE PERMIT NO. NFO qqq / / L� ° y/ .� 3 EINt FM MN.I.es: N ( I 1 O ' I 1 D I j S 1