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s/z‘hy Area 47. APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERITSilamt ENVIRONMENTAL HEALTH DIVISION -tt as 445 N SAN JOAQUIN, PHONE ( 209 )468-301P 3 P 0 BOX 2009, STOCKTON , CA 952011 n iv PERMIT EXPIRES 1 YEAR FROM DATE Illont (Complete in Triplicate) City SILO L kl-an Lot Si ze/Acreage La i 000 Owner's Name 0 IATh`t-tACU- TYPE OF WELL/PUMP: NEW WELL >5-. WELL REPLACEMENT El DESTRUCTION 0 Out of Service Well 0 ContractorN i.*) 1.-)v"1..‘7._ Addresa &Y S- 1(0 VI-4EL LicenWo. C Se) stz5 Phone/Po -6 3 1 -70 PUMP INSTALLATION 0 SYSTEM REPAIR 0 OTHER 0 Monitoring Well X DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE - --- - -- - FOUNDATION AGRICULTURE WELL OTHER WELL -PITS/SUMPS - - - - - ! T T it i Application is hereby made to San Joaquin County for a permit to construct and/or iitsta.'13,11t14 work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Raes and-Reghlations of San --- Joaquin County Public Health Services. Job AddressFea-C-ok t.1.. 4191 1.3s-0 wi:LARJ3,0 5.11400-- Address S wcs-k Sr\re:e_.+ Phone.:'8C0 -7171.2 TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Manteca Dia. of Well Excavation II"Dia. of Well Casing 0 Tracy Type of CasingCCA go Pktc:i 09-72:1;2 °'51-pecifications 5(4 4° El Delta Depth of Grout Seal (t, gee Type of Grout62,04-viAlg% 86,4,/-• I I Eastern Surface Seal Installed by H.P. State Work Done Sealing Material & Depth Filler Material & Depth INTENDED USE Cl Industrial .Ripomestic/ Public I I Irrigation Repair Work Done Well Destruction 0 4 0 Open Bottom Gravel Pack r.1 Other Rf Approx. Depth Type of Pump Well Diameter Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence ____ Commercial Other Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Capacity __ Water table depth No. Compartments Method of DisposalpAymear Distance to nearest: Well Foundation Property Line RECEIVED MAY 2 5 1994 qAN JOAQUIN COUNTY LNVPIRUOBNLMICENH LTH DIVISIO TEAALL HT E AH SERVICES SEPTIC TANK 0 Type/Mfg PKG. TREATMENT PIT. 0 Total length/size I I Depth Size Number I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances. 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 workman's compensa- tion laws of California." The applicant must call fo all uired inspections. Complete drawing on re er side. 6...) Title: ' , It \I 4 63 ta2t ) 1 11'4' Date: v 1- LEACHING LINE 0 No. & Length of lines FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS SUMPS DISPOSAL PONDS Signed X 17-71- Application Accepted by Pit or Grout Inspection by Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Servic Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, Opy i FOR DEPARTMENT USE ONLY ...•.C V Date / I Final Inspection by 0 , Date 7'4' 9Y • 0 W32i) 3501 A 95201 state laws, and . LI Distance to nearest: Well Foundation Property Line 0 . EH 13-24 IREV. 14 6) EH 14-26 FEE / ItiFfe AMOUNT DUE AMOUNT REMITTED CK it CASH RECEIVED BY -, PERMIT NO. -DATE— 13141"; 4131°1 111540 itz 5,2641 1°0.3232-