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, APPLICATION l SAN OAWIN COUNTT'PUHLIC HRALTH�SRVICES ENVIRQd TAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT =ina i X FROM DATE ISSUED . (Complete in Triplicate) Application is bereby amde,to San Joaquin County for a permit to construct and/or install the work herein described. This application is nada in collpliance with San Joaquin Countj, Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin Count,)r Public Health Services. Job Address 4648 City Stnrkton Lot Size/Acreage Dwne,•s Name Jonathon Marlowe Address P.O. Sox 150-211 Phone 457--1 62, San Rafael, CA 95915 Contractor Wes H, z t Address 1803 W, March_ __LnL #�dense No. �6�9 Phone - 264 TYPE OF WELL/PUMP: NEW WELL © WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 0 Monitoring Well R ( 3 DISTANCE TO NEAREST: SEPTIC TANK n1 a SEWER LINES n Ja _ - DISPOSAL FLA. n 4a PROP. UNE ]_no FOUNDATION --J-0—' AGRICULTURE WELLn/a OTHER WELL—I-9D-'—1 PITS/SUMPS =,L.a INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial - ❑ Open Bottom I3 Manteca Dia. of Well Excavation Dia. of Well Casing n Domestic/Private X1 Gravel Pack C1 Tracy Type of Casing PVC - Specifications I'1 Public Cl Other n Delta Depth.of Grout Seat 90 , Type of GroutNRPt C010=1 { 1 irrigation —Approx. Depth ki Eastern Surface Said Installed by Flush grey well c V Repair Work Done U Type of Pump H.P. State Work Done Well Dastruetion ❑ Well Diameter 211 Sealing Material i Depth Ori a , 2 r Filler Material i Depth TYPE OF SEPTIC K: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 INo septic system permitted it public sewer is available within 2W feet.) Installation wig sow: Residence— Cornmarciel,.W,. Other Number of living units: Number of bedrooms .t Character of will to a depth of 3 fest: Water table depth SEPTIC TANK ❑ Type/Mfg CapacityNo. Compartments PKG. TREATMENT PLT.Cl Mathod of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 8 Length of lines Total length/size FILTER BED O Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line tJ DISPOSAL PONDS 0 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, stats law*, and rules and regulations of the San Joaquin County Homs owner or kenMd agent's signature certifiss.the following: "I certify that in the performance of the work for which this permit is issued. I shall not empty any person in such manner as to become subject to workman's compensation laws of California."Contractor's hiring or sub-contracting signature urtifm tits foNvwkW."I certify that in the performance of the work for which this permit is issued,I"I employ persons subject to workman's cornpenss- tion lave of Caw«nia." The 811pGcattrequired tions. Complete drawing an reverse side. Signed Title: Oats: zft, _ FOR DEPARTMENT USE ONLY Application Accepted by % Date Pit or Grout inspection by Date '2�' Final Inspection by -- - Additional Comments: __kraal root j $-J e-o^-4cy#cA. -m W Z. e'gPir4L-4L Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services -5fa 445 N San Joaquin, P O Sox 2009, Stkn, CA 95201 NFO FEE AMOUNT DUE AMOUNT REMITTED CK C/AS�Hq RECEIVED BY DATEPERMIT'NO. • E1413-24MEV.Y/N51 4, O� :-EJ I..::. �/�lm I -IS-Z4.12- i.. Zo%'� Elf 14>♦ 4341._o-al