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510.3739211 IE H2OGEOL 640 P01 OCT 04 '95 10:05 $AN �OAQUIN COUNTY PUBLJC UALTH SERVICES EN'VIROXXIMAL EXALTS DIVISION 44a N SAN JOAQUXN, PRONE (209) 168-25120 P 0 BOX 2009, . STOCKTON, CA 95201 P.�EBM I T ESP RI ES 1 YEAR-FR9M DATE ISSUED (Complete in&T"'iplj,c�t�e}, APPliastton to hereby tae4e,to sail J04 uln County for a percllt to cone rust and/ r�nettml t1 vork 1 r t c d. Thta application to rmadc in compilisnce with Ban Joagvin Cointy O di arp N 5 nd bEtErJ J �ia lone or San Joagvin County publie ealth SZrceb. Job Addle;t �� .� 7 .�� Crty 714 Owners Name _ Address �'�'Y` Pnan160 Centtactof�,7A S4" f fe �� — Phone p...`J.l, �� TYPE OF WELL/PUMP: NEW WELL C7 WELL REPLACEMENT Cl DESTRUCTION 0 Nt of Be17yice Wtll P PUMP INSTALLAT10 0 SY TE REPAIR C^' ^^,,��T}{E HonitorSrtg til i� DISTANCE r0 NEAREST: SEPTIC TANK � SEWER LINES 171SP JSAi FL // FAOP. LINE� fti. FOUNDATION _ `- AGRiCL:LTURE WELLOTHEP WEt-t " -7(� T PIlS/ Ul�p_S yINTENDED USE TYPE OF WELL PRO_BL_£M AREA CQN$FAUC_tt011 SP[CIFICAT10Nt� 5 Yi / ( ' ( �� ('I Inauaneh U Open Bottom 1-� h'ianleca T Ora, O1 Wall Ekcayauon —_ 4ia. o Well Cacin f.l bomestictpfivete 0 Gravel Pack �� Tracy Type of CasinQ___...r_,�.....�.._._ Specification t 1 I'l Public 0)her b;71 A-Qn Deft& Depth of Grout SeaE 7yPa of Grou l I Ir+ipation 7-9! Approx. 0a I I Easiern Surface Soul Installed by Repelr Work Done U Type of Pump H.P. State Work bone Well clasituction 0 Well Diameter Seal2ttb Leser Ss' Depth Depth Filler Materia] 4 Depth TYPE OF SEPTIC WORK' NEW INStALLAYION I i f-tEPAIR/ADOITION i i DESTRUCTION I I i►aa cepric system permitted if p%#Mic sewer is availabie within 100 fe41.1 i Installation will serve: Residence Coi:Amo(611 — Other t4umber of living vnits: — Number of bedrooms Chetactor of coil to a depth of 3 feet; ._ -. r ----.---•-.-... _. __---Water table depth--- -- .-_ SEPTIC TANK 0 Typo/Mfg _.__ Capacity _._ No. Compor4ments PKG, TREATMENT PLT, n Method of Disposal 01;%Anca to nearest: Well foundation T Property Line LEACHING LINE 0 No. & Length of lines Total iongth/tiza _,,, FILTER BED �j, Cl Distanoo to nearest: Well " Foundation __,_,. Propeny Line SEEPAGE PITS I I Depth Site - SUMPS rt— LI Distance to nearest: Well _• Foundbl'on Pronarty line DISPOSAL. PONOS El _ I hereby certify that t have prepared this application and that the work witl " done in sccorci8net v.. San Jot} ,t(i�so t ¢r ccs, state laws, and r... rules and regulations of the San JOaQVin County ��' ��+ Home owner or licensed aQant's alonature certifies the tollowing: "I comity that in the porformance of th+ wr�{�;Jzl(whicll 0116 Per efilj 'asued. I shall not arnptoy any parson In such manner As 10 bacoAle 4vblect to workman't Cor`�penRAlion laws of ColifOrn'a." lr afC(Pl��t '47 Q t?rt4 OG'1ing signatVre certifies Lha following; "I Certify that to the perforrrlanea of the work for which thit permit Is issued,I ihh1r Io persorllF t{b}Act tow rk en's cempanse tion taws of Callfor The applicant m all for all req a lnctaecttont. Complete dtewing 0n reverse tido. t.�. •• •� ppt� `o CEOats:ST $lgnpd X .........._. Title: Gj 1 Ll u C4/ �"�• • Oats: FOR DEPARTMENT USE ONLY Appllcallon Accepted by ` �" `YC.». ,:� � �� . ��..,,,.. bate � Arae Pit or Llrout Inspection by Date Final Inspection by. _ Data f i Additional Com—ritl: A1.I01eant - Pvtvrn all evlrioel to: Son JOngV1.n County Public, Health Servs,;r:r Eevironmoetal Hoalth Permit./Servicer; 44S 14 ken Joaquin, f' 0 Box 2009, etkn, CA 65201. IFEt NFO AMOUNT DUE AMOAFIAI' r1D " CASK — RECEIVED til' _ PaYt PERM17 NO. LM 1l•71 IDLY.1rKn+ r... C// r