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0 �Rn SANTOAQUIN COUNTY PUBLIC HEALTH FRVICES v ENVIRONMENTAL HEALTH DIVIS �D 440N SAN JOAQUIN, PHONE (209)43420 5OM1 P 0 BOX 2009, STOCKTON, CA 95201 JUL U 1. 1993 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIRONMENTAL HEALTH (Complete in Triplicate) App I145{>Rueseoy made to San Joaquin County for a permit to construct and/or install the work herein described. This application Se made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Sen Joaquin County Public Health Services. Job Address 110 EAST TURNER ROAD City LODI Lot Size/Acreage ACKEL PROPERTIES Adme115340 YARMOUTH _�QQ__$LyCjIyQ_Cet►o�e __..__....._____._._. Cpntldtl0i, /�A G'pGCI �dressp /� � 'C - icense No. TYPE OF WELL/PUMP NEW WELL ❑ WELL REPLACEMENT fl DESTRUCTION D Out of Si ce Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER L7 '�° In Wll 0DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA DISPOSAL FLD. A PROP. LINE FOUNDATION NA AGRICULTURE WELL �_ OTHER WELL NA PITS/SUMPS blA- SRS'I INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS fl Industrial O Open Bottom ❑ Manteca Die. of Well Excavation Dia. of Well Casing [I Domestic/Private O Gravel Pack ❑ Tracy Type of Casing_ Specifications 1'I Public 1-1 Other n Della Depth of Grout Seal Type of Grout-4-WKS q Ib I I brigabon _ Approx. Depth 1 I Eastern Surface Soul Installed by ,009�Q m9C Repair Work Done 0 Type of Pump H.P. State Work Done _ Well Destruction O Well Diameter Sealing Material & Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 INo worts system permitted if public sewer is available within 200 lest.) Installation will serve: Residence _ Commercial_ Other Number of living unite: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. O Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 8 Length of lines Total length/size FILTER BED O Distance to dearest: Well Foundation Property Line SEEPAGE PITS 11 Depth__Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby cenify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rule& and regulations of the San Joaquin County Home owner or licensed agent's signature cenilies 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'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 applicant mu t/call-four all rrect .red dIpiI s ions Complete drawing on rover"side. Signed 1✓�.t.. !/�r�/ �`9'..f' Title.�.�/��/ — Date: �7--/� FOR DEPARTMENT USE ONLY 5F 2y 5/ Application Accepted by r// I�K-/�f�l�/Il J Date Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 IN AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. . EH tllt IAtV Ireei 1 oo I q5 �7 . Z�3 93. 120k tH 1&al i