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L-La �� SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application Is hereby mede,to 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 1662 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 16042 E. Baker Lane City Linden Lot Size/Acreage Owner's Name C & A La9CM.T si no Address1 l E Bakpr-, T.i nden Phone 209- 87-3554 Contractopurvlance DrilleS,Inc.Address P.O.BoX 64,Linden License No,377923 Phone 209-887-3554 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION XkOut of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing CI Domestic/Private M:`❑ Gravel Pack El Tracy Type of Casing_ Specifications I"I Public-" r El-Other— .;--_,n_Delta--- —Depth of-Grout-Seal--- Type.of.Grout� I I Irrigation _Approx. Depth I I Eastern Surface Sedl Installed by backf 11 14— 7Q� S® - on-- Repair Work Done �0 Type of Pump H.P. ,State Work,Don _ �' r C O Well Destruction Well Diameter Gl Sealing Material i Dcptih t 'J0 t `9Sc Ck sand & CelTlent t/ Depth «Jr✓ Filler Material & Depth Sand TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I [No septic system permitted it public sewer is available within 2001 eet.1 Installation will serve: Residence_ Commercial— Other 4 Number of living units: Number of bedrooms / Character of soil to a depth of 3 feet: I Water table depth SEPTIC TANK ❑ Type/Mfg I Capacity No. Compartments !!) PKG, TREATMENT PLT, ❑ 1 Method of Disposal I j Distance to nearest: Well Foundation Property Line LEACHING LINE LI No. & Length of lines Total length/size FILTER BED C1 Distance to_,nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth ' ' Size Number y SUMPS LI Distance to-nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I 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 1 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 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 applica must call fqrjall u' spections. Complete drawing on reverse side. Signed Title: President _ Data: 2/16/93 FOR DEPARTMENT USE ONLY / Application Accepted by Date 1-7 Area 12`/ t Pit or Grout Inspection by ` Date Final Inspection by Date Additional Comments: %� 415 1,1164 '", 93�6 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 INFO AMOUNT DUE AMOUNT REMITTED CK H RECEIVED BY DA/E PERMIT NO. EH 14.2 IREV.1i851 1,7 / 0 _ �j ! `•'s / EH 0 1420 V l/ ✓' I