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- APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE.. STOCKTON, CA Via( �• `pM Telephone 12081 4666781 PERMIT EXPIRES 1 YEAR_FR_O_M_DATE ISSUED F--B t ' fG91 _— --� (Complete in Triplicate) - - - — ENv'n' i\ `4t�p („Ips'T� , 'n t wF.e9 App:iwtion n hemby merle le Na San IoeUmn Local Health DisUict for a�Yfmii ir•vtnsbuct and/or install tM1v work her lea made in compk,H.will,San J.oMau Coumv Oulrrapco No.110 for i nwe9e or Nig 0442 he w1h/Pump ani)the Ruins an Wet al. tiro Local Health Dnlrict. job Address _1190.0__�L__FJUyJid.-- _-_ _ City— Lot Size PM owrrels Name _BEAR__CREEK_WINERY— Address Furry_Rd-- Phone ----- - 17754 N. Hwy. 88 727-5548 Dpmracmr_GOEHRIN�f PUMP Addtca_LDekeford.CA ___LlcenseNo.309031 TYPE OF'WELL/PUMP: NEW WELL CI WEI! REPLACEMENT I] DESTRUCTION 11 PUMP INSTALLATION P SYSTEM REPAIR XX OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES ____ DISPOSAL FLD._ PROP.LINE _- 4 FOUNDATION___=AGRICULTURE WELL_=OTHER WELL PITS/SUMPS _- INTENDED USF TYPE OF WELL P9DBLEM AREA CONSTRUCTION SPECIFICATIONS__ I-,i Industrul ❑Open eonom ❑Alamaca Dia.of Well E.cavation_ Dia.of WaR Casing _ it Domestic/Pr'rvales 1.T Gravel Pack (I T.acq Typa of Casing Specifications — ('I PVMic r Other I1 Dehe Depth of Grout Seal Type of Grout= --- 1 1 In"oon _Amex.Depth I I Eastern Surface Seal Installed by Ropae Work Done $I Type o1 Pump -Turbine H P —40 --- State Work 0.017*pa i r 40}"&ter_l ube �- %Yell Destruction ❑ Well Diameter Scaling Mate.ie:Imp 50') __ _ i—rb10e Depth _ Filter Material(Below 501 _Found TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I : DESTRUCTION I t INo supe system permitted it PuLuc Bawer n mailable wahm 200 feel.) _ T Installation win serve: Hesidence_ Cotommcul_ Othm -' Number of living units:_ Number of bedrooms_ .- I Character of wil to a depth of 3 feel:-_— ---- .Water table depth (.l�E� SEPTIC TANK U Type!Mfg _ _ Capacity._— No.Compartments - — /b PKG.l'REATMENT PLT,LI -- - _Found_.—_- - Method PI Disposal Distance to rwarMb Well Foundation___ Pn•Ixay Line LEACHING LINE Ll 8 Length of lines _ - Total lenryh Property Distance sf _ .— �•` FILTER BED 11 Distance ro nnereWFoundationl Foundation___ Prolwrry Lirle �•J t SEEPAGE PITS I 1 Depth _..- Site___.__ Number 1z SUMPS I I Distance to nearest: Was_Found Foundation __ Property Line C DISPOSAL PONDS I I _ I hereby candy that I have prepared this application and that the work will w done ir accordance with San Joaquin county ordinances,state lawn,said _ reran and regulations of the San a9uin Local Health Dhoict. Home own,ce hcena,f npen' nature caemfiea the following:"I cunity that in the performance o!the work for which this permitis it s wued.I shall not amply any perwn&chl,aa to becstillest to workman's compensation Wws of Coliform;"Contncmra biting or wD<ontractia0 fig^ature oh dies the forever deepermance of the work for which this permit Is Issued.1 sFall employ personasubject to wokman's compen ea I i•n laws d Califorrhe applicant must +d inspections. ComMele drawing oP reverse side. Signed Y- �r ____ ole:_Bkpt.-- Date: 2 7 91_ . //y/�.(� POR DEPARTMENT USE ONLY / 1 Date -/� AT. r ApF•lication Accepted by Date_. _ Fxmt Inspection by- Data Pb or Grout Inspection by _.____-- / Additional Comrrvents: -- 11 Site 466 6261 ❑Lodi 3693621 ❑Mont. 823-7104 ❑Tracy 8356385 Applicant-Return a0 copies to: Envimnmantat HeaRh P,mit/Servicas 1601 E Hezeilon Ave.. P.O.Be.7008,Sit-CA 95201 IEE AMOUNT PUE Ak1DUNT REMITTED CASH RECEIVED BY DATE I PFRM�N0. INfO fRHeaMy yseo 1'Yl� IS -9 9I 3sb P IN IrM l�