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Mork plan faxed to APPLICATION FOR PERMIT Elnore 3atliff SAN JOAQUIN LOCAL HEALTH DISTRICT 2-21-90 by Nolte & 1601 E. HAZELTON AVE., STOCKTON, CA =-,7soc. Stenhen fennin- Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health 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 of No. 1862 for"It/pump and the Rules and Regulations of the San Joaquin Local Health District Job Address 18846 TZ Irrf 99 City LOC-1 Lot Size 55 11C PM Owner's Name Victor :,'ine foods Address P .O . Box 147 84i Ca,l .9524t(,. 8-51171 Corning,Cal. 9 021 Contract,North Valley 'DrillAdW s Inc . P.O. Box 108 License No. 418834 Phone916-824—01 2 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION Cl SYSTEM REPAIR ❑ OTHER 25 Monitoring 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 ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing tl ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing SCh. 40 PVC Specifications M Public ❑ Other Ll Delta Depth of Grout Seal 10, Type of Grout Neat CeIDe I I Irrigation 2_t Approx. Depth I I Eastern Surface Seat Installed by Oepient _ Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 501 Monitoring Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION 1 I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments r PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation--Property Line LEACHING LINE ❑ No. 8r Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line 1 SEEPAGE PITS I 1 Depth Size _ Number SUMPS CI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state taws, and rules and regulations of the San Joaquin Local Health District. Home owner or licensed agent's signature certifies the following: "I certify that in the pelormance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's 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 compensa- tion laws of California." The appli t must call for all requ a in ctions. Complete drawing onj!6��"rrse�side. 7/p Signed ( Title: tom_•- �/ Date: �— DEP ENT USE ONLY Application Accepted by �,/f�-✓I Date V Z�'!G Area 21 Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: D��r�i�iJ ✓/N/. f/��H��rN ❑ Stk 466-6791 L�-3621 ❑ Manteca 823-71 ❑ Tracy 835-6395 � �{ fel /V rJ T C e 6 �T Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 952D1 ( Y FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BV DATE PERMIT NO. INFO n . EH 12-24IaEV.11n5i EH 11- T, � 1e /