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ii SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES $ ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 „ P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Applicatlon is hereby made 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 1862 and the Rules and Regulations of San Josquin County Public Health Services. Jab Address 6831 E. WATERLOO city STOCKTON Lot Size/Acreage owner's Name AMALIA ALCALDE Address SAME 95215 Phone 931 -6$37 o NOACK PUMP CO. Address 4500 E. FRCA 95 ST Contractor License No. 504513 Phone 948-8817 TYPE OF WELL/PUMP: NEW WELL 173 WELL REPLACEMENT Cl DESTRUCTION ❑ out of Service Well ❑ 'PUMP INSTALLATION IN SYSTEM REPAIR ❑ OTHER O Monitoring Well DISTANCE TO NEAREST: SEPT C TANK '' SEWER LINES DISPOSAL FLO. PROP. LINE I FOUNDATIONS- AGRICULTURE WELL OTHER WELL PITS/SUMPS `UNTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca - -Dia. of Well Excavation Dia. of Well Casing t Domestic I Private ❑ Gravel Pack ❑ Tracy Tyr'gf Casing_ Specifications J Cd Public i-7 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation Approx. Depth I 1 Eastern Surface Seal Installed by Repair Work Done U Type of Pump SUB H,p. 3HP State Work Done PULL TURBINE PUMP Well Destruction ❑ Well Diameter Sealing Material & Depth AND REPLACE_MITH SUB PUMP It 'I Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION i I DESTRUCTION I I (No septic system permitted if public sewer is it available within 200 feet.) Installation will serve: Residence T Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: -Water table depth i SEPTIC TANK. ❑ Type/Mfg Capacity - No. Compartments PK& TREATMENT PLT. ❑. # v Method of Disposal ; �_J Distance to nearest: Well Foundation Property Line a ; � LEACHING LINE Cl ,No. & Length of lines Total Lerigtth/size FILI ER BED ~'' ❑ Distance to nearest. Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number ° SUMPS L'I Distance to nearest: -Well -Foundation ` Property Line DISPOSAL PONDS ❑ - x I hereby certify that I have prepared this application and that the work will be done 1n 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 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 workmen's compensa- tion laws of Call II 11 — The applicant mu call call far all r uired i t' s. -plate g on reverse side. _" Signed x Title: RETAIL SALES Date; � t FOR DEPARTMENT USE ONLY Application Accepted by Date /Z- Area Pit'lor Grout inspection by Date Final Inspection by Data Additional Comments: 11 Appllcant '-.Return all copies 'to: San Joaquin County Public Health Services j -. Environmental Health Permit/Services San �-�- 445 N Joaquin, P d Box 2009, Stkn, CA 95201 IFEE NFO AMOUNT DUE'. ' AMOUNT REMITTED GASH RECEIVED BY DATE PERMIT'N0. . EH 13-2/141REV.i M6) �J �-r` Q- !t' t(!'� -l�2 YZ- z 3 EH 14.25. 'a i