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APPLICATION I �R- �" 3 b/ 2/ --- SAN JOAQUIN COUNTY PUBLIC HEALTH 3 VIBR CES ENVIRONMENTAL HEALTH DIVISI 342 # 445 N SAN JOAQUIN, PHONE (209)468 34A P O BO% 2009, STOCKTON, CA 952 fAC # PERMIT YEAR D TE # (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the wort herein descrlbed. This application is ori in compliance with Ran Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Putlic Health Services. Job Address 6888 N. Wall Rd. City T.i ndan Lot Size/Acreege Owne;a No"Edward Giannecchini Address 18857 E. Comstock Rd. ,Lindypne Contractor Pulviance Drilles,IncAdd,ess P. O. BOX 64,Linden,CA License No. 377923 Phone 887-3554 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT M DESTRUCTION ❑ Out of Service well Cl PUMP INSTALLATION It SYSTEM REPAIR C OTHER ❑ Monitoring well ❑ DISTANCE TO NEAREST: SEPTIC TANK _ SEWER LINES DISPOSAL FLD. PROP. LINE G•� FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS v INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial Cl Open Bottom CJ Manteca Dia. of Wall Excavation_ Dia. of Well Casing ot1 C1 DO"Sli /Phvate C7 Gravel Pack ❑ Tracy Type of Casing_. Speciliutions I'I Public 1:1 Other n Delia Depth of Grout Seal Type of Grout 1 1 Inigatfon _Approx. Depth I I Eastern Surface Seal installed by Repair Work Done ❑ Tylia of Pump 16 2dkr H.P.mk 30 State Work Done_ \C Well Destruction ❑ Well Diameter Rotating Material L Depth Depth Plllc'Material Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I 1 REPAIR/ADOIIEtON 1 I DESTRUCTION I I (No mplie system per matted it pudic sewer is avaaaDls within 200 leel.l Installation will serve: Residents _ Commercial_ Other Number of Irving unite _ Number of bedrooms Character of soil to a daplh of 3 fast Water table depth SEPTIC TANK ❑ Type/Mfg Ca* 1 No. Componmenta (� PKG. TREATMENT PLT. ❑ RECEIVED Method of Disposal Distance to rwerest: Well Foundati o-1, �Wpony Lim �M �U l}.77 sLJ�J� LEACHING LINE Ll No. S Length of linea _ ^�1,jf�AQVy ka,,a�� FILTER BED ❑ Distance to nearest: Well Fool d L I{Wk4 FNVIRONME 4�1E��;per SEEPAGE PITS 11 Depth _Size Number SUMPS LI Distance to merest: Well Foundation Property Lina DISPOSAL PONDS ❑ I hereby comity that I have prepared this application end that the work will be done in accordance with San Joaquin county ordinances, stats laws, and Fuel end ragutibbo n,of the San Joii County None ownst or Neonaed agent's signature carriers the following. "I certify that in the performance of the work for which this pertrkt is issued, I Met not employ any person in Such nannar as to become subject to workman's componaation laws of California." Contrscto!s hiring or sub-contracting signature certifies the following: -I comity that in IM performance of the work for which this permit is issued, 1 shall employ persons subject to workman's compensa- tion it" of CatlonY." The rin f caw for Ii r quu inspatctions. Complete drawing on rwerb side. Corporate Secretary 5/9/95 signed Title: rpOra was: _ FOR DEPARTMENT USE ONLYji /y�! Alpkcation Accor.<W by Q,y� Date Pit or Grout Irypection by Dats Final Inspection by Dna Additional Commants: Applicant - Return all copies to: San Joaquin County Public Health Servtcee Rpvi ronaen tai Health Pe Bolt2009, cos 445 N Stn Joaquin, h O Box 2008, c. CA 201 PE AMOUNT DUE AMOUNT REMITTED (ASN E EIVEO BY PERMIT NO. EN `0 hast OV '� EN lsa