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AEFL4-GATION SR SAN QUIN COUNTY PUBLIC HE�ILTHEWAN 2YPIRONMENTAL HEALTH DIVISION � f, , 445 N SAN JOAQUIN, PHONE (209)468— ^ IVB e� P 0 30% 2009, STOCXTON, CA 9520 J'.j' PERMIT EXPIRLS I T—r4R FROM DATE IS SEF 1 1994 (Complete _z `Triplicate) arse 27-ib-U-14 Application is hereby ode :o San Joaquin County .'or a per=t :o construct and/or 'asta i, :he vor)t herein described. ":tis sp�Ilt iC�rfgrtlt'�TsadgE TTComplianee with San .:oaqula Couaty Ord- ante so. 749 and 1862 and :he Rules and iegulat-oas of San oagna3� b�3¢s Health 3ervlces. Job .address DRQ Fast Fath $trppt City Tram/ :,at Size/Acreage 16 arrpt Owner's Name S.outhprn Rarifir Tranc rAouress One Marlrpt -Plaza , C F , r'a CIA,1(lFshone _ Company - ' ContractorW.Q'c i u'7ma t gyri l l i nn Aaaress 12 !icrnse No.(975nag7q P6+ane (91 Fi) fi3R_7 76 TYPE OF WELL/PUMP: NEW WELL _ W e LL :a EP LACEMENT DES 7 RUCTION a Out of Ser-rice 'net ; PUMP INSTALLATION — SYSTEM REPAIR Z: OTHER I Monitoring yell Q 10 shallOWSoll borings OISTANCE TO NEAREST: SEPTIC TANK >50' SEWER LINES 0' DISPOSAL ;LO. N/A PROP. LINE ISI/LA L FOUNOATION N/A AGAICULTURE 'NELL N A OTHER WELL N/A PITS/SUMPS � INTENOED USE TYPE OF WELL P4C13Lc'M AREA CONSTRUCTION SPECIFICATIONS wA(ld1 ti Ond I borings may be ! Industrial C Open donor Manteca Oia. of Well Excavation ne—,34uOAeilItC� later date: ng OomesticiPrivate Q Gravef'Pack J[ -racy Tvpe of Casing Specifications Cl Public I other Oeita Oeatn of Grout Seal 0 to 31 Type of Grout rpmpnt/RiontnMj to Irngation _Aoorox. Oeoth Eastern Surface Sedl Installed w ]rillpr Repan Work Clone Ll Type of Puma H.P. State Work Done _ Weil (Destruction C Well Oiameter Ses.L'ng Materia.1 L 3epth Depth ?SL'er Yatertal i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION REP41R/ACOITION OESTRUC71ON i I !No saouc system permuted a public sdwer :s !� available within 200 test.) I Installation will serve: Residence_ Commercaf_ Ctlier i Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water taws depth SEPTIC TANK 0 Typo/Mfg Capacity 40. Comoartn+enta PKG. TREATMENT PLT. U Method of Disposal Oisiancs to nearest: Weil Foundation Property Line (�\ LEACHING UNE ❑ No. 3 Length of lines T'otaf tengtn/size i FILTER BED 1:1 oistancs to nearest: 'Neil Foundation Property Line j i SEEPAGE PITS 11 Depth Size Number SUMPS Ll Oistancs to nearest: Weil Foundation Proper/ Lino DISPOSAL PONOS I hereby certify that I have prepared this appficatfon and ;hat ins work wail os done in accordance wifn San Joaquin county ordinances, state laws, and N rules and regulations of the San Joaquin County Home owner or licensed agent's signature cKtlfies the following: "I certify that in the performance of the work for which this permit is issued. I snail not emofoy any person in suer manner as to become suowc:'o workman's comoensation Laws of California." Contractor's ninng or suo-contracting signature certifies tris following! !certify that in ten performance or ins work for which this permit is issued, I small employ persons subject to workman's compensa- tion laws of CalfforMla r' The applicant muss tall for all requirtrd i Clete drawing on r*l rss,.de. Signed X \ v �-- _ rn.:2-o�_. tG o ,�� Data: September 13, 1994 FOR DEPAAThAENT USE ONLY Q Application Accepted by Oats_ ` ?'7 � Ansa Pit or Grout Inspection by C Oa Final Inspection byC® P Date Additional Comments: SLS J �is — r"""� , A. No- Applicant - Return all copies to: San Joaq my Public Health Servi,;ea 3n•i-oamental Health Permit/Services 445 3 San Joaquin, P 0 Box 2009, Stita, CA 95201 T9 O 1 FEE AMOUNT OuE AMOUNT PEMiTTED �� H AECFIVEO 9Y ! OwrE PERMIT N0. INFO / T LSA EM i1.I.ikN,ir.si r( !/ / EM i��