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16t1i E"^�N:c_` -.•L -`T y PERMIT NO. Telephone (_09; 466'67C1 — DATE ISSUED -7//,P �- PEP.MiT EMPIRES-1 YE:.R FRO..M DAT E ISSi1E1) (Complete .n lrlpl,cate) Application is hereby made to the San Joaquin Local Healtn District for a permit to construct and/or install the work herein described. This application Is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaauin Local Health District. Job Address 11931 E. Norman, Stkn Subdivision Name — Owner's Name C . E. Ahrens Address 11931 E Norman, Stockton Phone _ Contractor's Name Clark Well & ECjUlPicense No. 371560 Phone 462-7676 TYPE OF WELL/PUMP WORK: NEW WELL ❑ WELL REPLACEMENT I`1 DESTRUCTION PUMP INSTALLATION (� SYSTEM REPAIR OTHER �) DISTANCE TO NEAREST: SEPTIC TANK. SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION _ AGRICULTURE WELL OTHER 'aELL PITS/SUMPS INTENDED USE TY.^E OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS c/J IJ Industrial Ll Open Bottom ❑Manteca Dia. of Well Excavation Oomestic/Private Gravel Pack L� Tracy Dia, of Well Casing — (] Public Other U Delta Type of Casing Lj irrigation ( Approx. Eastern Depth Specifications _ F-1CathodicProtection Depth of Grout Seal — LJ Geophysical Type of Grout l.J Other Surface Seal Installed by Repair Work Done Wj Type of Pump -I)b N.P. _3 State Work Done Ingta1 1 lap Well Destruction lJ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 50') �r TYPE OF SEPTIC WORK: NEW INSTALLATION �; REPAIR/.ADDITION j7] (N) septic tank or seepage pit permitted if public sewer is available within 200 feet.) Vv Installation will serve: Residence _ Commercial _ Other Number of living units: Number of bedrooms Lot size Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK 1. Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. Lf Type/Mfg Capacity Method of Disposal SEWAGE SYSTEM Distance to nearest: Well Foundation Property Line DESTRUCTION U —J LEACHING LINE iJ No. 8 Length of lines Total length/size FILTER BED L; Distance to nearest: Well Foundation Property Line SEEPAGE PITS Ej- Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS C1 I 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 District. Horne 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 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 compensation laws of California." The applicant must call for all required inspections. Complete drawing on reverse side. Signed x Title: Sec-Tres , C lark Well Date: 12 3 ARTMET�T)USE ONLY � Application Accepted by E L Area —�— Stk 466-6781 Additional Comments: Lodi 369-3621 r.. Pit or Grout Inspection by / moi_ / &- a_t.e U Manteca 823-7104 Final Inspection byate ? —�'�' CI Tracy 835-6385 applicant - Return ap-copies to: Environmental Health "ermit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 952.01 Tr, - n P[P.MIT Nn. FEE BASE AM.0U,*IT DUE AMOUNT LC'I" RECE.lED BY DATE INFO --- -- --- ---- -- ------- -- - -- } --- — on Ln a-14 RL'.. I. . IA-,1;