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APPLICATION FORPER� i" SAN JOAQI il' LOCAL �,.-_ALTH D-IS-RICT 1601 E. HAZELTON AVE., STOCKTON, CA PERMIT NO. Telephone (209) 466-6781 DATE ISSUED PERMIT EXPIRES I 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 or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 18446 Walnut Street G (al" ubdivision Name Owner's Name Carl Enos Address 18446 Walnut St. , Clemen.tsphone Contractor's Name Goehring Pump License No. 309031 Phone 727-5548 TYPE OF WELL/PUMP WORK: NEW WELL WELL REPLACEMENT DESTRUCTION PUMP INSTALLATION SYSTEM REPAIR OTHER DISTANCE TO NEAREST: SEPTIC TANK 50+ ft. SEWER LINES 50+ ft. DISPOSAL FLO. 60+ ftRQP. LINE 11 & 20' FOUNDATION 3 8• AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial PCIOpen Bottom F-� Manteca Dia. of Well Excavation 1 211 to 501 L7q Domestic/Private F_�Gravel Pack F� Tracy Dia. of Well Casing 8�� D Public F-1 Other Delta Type of Casing Steel D Irrigation 2401 Approx. Eastern Specifications ED Cathodic Protection Depth Depth of Grout Seal 50' ❑Geophysical Type of Grout 2 to 1, 9 sack Other Surface Seal Installed by contractor Repair Work Done EJ Type of Pump Sub. H.P. 3/4 HP State Work Done Well Destruction NJ Well, Diameter 811 Sealing Material (top 50') concrete Depth 140# Filler Material (Below 50') washed sand x TYPE OF SEPTIC WORK: NEW INSTALLATION r—j"%RtPALR/ADDI'TIOM E] (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) 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 U Type/Mfg _ Capacity No. Compartments PKG. TREATMENT PLT. Type/Mfg Capacity Method of Disposal SEWAGE SYSTEM Distance to nearest: Well. Foundation Property Line DESTRUCTION LEACHING LINE No. & Length of lines Total length/size FILTER BED Distance to nearest?' Well Foundation Property Line SEEPAGE PITS F-1 Depth Size Number SUMPS El Distance to nearest: Well Foundation Property Line DISPOSAL PONDS EJ I hereby certify that I have prepared this application an ii 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. Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I10all not employ any person in such manner as to become subject to workmans compensation laws of California." Contractor's h' or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is fird shall employ persons-subject to workman's compensation laws of California." The applicdn� f r all required inspections. Complete drawing on reverse side. l Date: 06/25/86 Signed X ;�� ,� / Title: Bkpr.. R D ARTMENT USE NLY �j `G` �`❑ Application Accepted �/+� Area / U !7 S t k 466-6781 Additi omments: , 01E. Lodi 369-3621 Pito Gr Inspection y � Date tton Manteca 823-7104 g!�Final Inspection by ` ' Date Tracy 835-6385Applicant - Return all copi s t : i onmental Health Permit/Services 1zve., P.O. Box 2009, Stk., CA 95201 FEE BASE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. INFO --73 1 CD S• o� �- Fs�o-?3 L I EH 13-24 REV. 10/82 10/82 500 14-26