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SANO"UIN COUNTY PUBLIC HEALTH CES 1V) g��1111 WIRONMENTAL HEALTH DIVISI� , J�i�(� Jlvll 44:-1 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 JUL 0 1 1993 (2trs� S2�'- �s6Yg PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIRONMENTAL HEALTH (Complete in Triplicate) AppPEWV 3dSERY1C deto San Joaquin County 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 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 110 EAST TURNER ROAD City LODI Lot Size/acreage Owner's Name // ACKEL PROPERTIES Address 5340 YARMOUTH #308 ENCINO CiNone Contlactoljq!'s /1/111' ,5•dL*ce/1ddresspPw 0 ice8�No. r3 z� Pnone�o �'u-1 O TYPE OF WELL/PUMP. NEW WELL ❑ WELL REPLACEMENT Ci DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ff, 0it Ing Well ❑ DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA DISPOSAL FLD.�gA PROP. LIM1E..-NA— +At Y FOUNDATION NA AGRICULTURE WELL --NA--- OTHER WELL NA PITS/SUMPS DL4- S1rl INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing (I Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications I') Public 171 Other fT Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material L Depth Depth Piller Nsterial It Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION 11 (No sti system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other C7 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 PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line . LEACHING LINE ❑ No. B Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Propeny Line ) SEEPAGE PITS 11 Depth_ Size Number SUMPS LI Distance to nearest: Well Foundation Property Lina DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations Of the San Joaquin County 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, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or subcontracting signature certifies the following: "1 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 tno noJ for all r red i a one. Complete drawing on reverse side. Signed 4 ;,+2,/� Title: Date: //� FOR DEPARTMENT USE ONLY //1ski �L�✓l Application Accepted by rl' �KL^""' Date Area Pit or Grout Inspection by Date Final Inspection by �I 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 FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT N0. ell . EM t}ir IaEV 11.51 C .1/Ll I q5 �. Zit 3 93• i25� EM tr.m 1