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r� F APPLICATION FOR PERMIT i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED {Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District 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 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. f Job Address 1 250 NORTW WTI Sf1N WAV _ __ City ;TnrrrT, �,, w Lot Size PM i Owner's NameTHRTFTY TI COMPANY Address Phone 213 923-9876 , SPECTRUM EXPLORATION.1 INC. 2825 E. MYRTLE ST. STOCKTON G-57 512268 209 498-2720 Contractor Address License No. Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER-IN=FOURm2O2EOOT:SOIL DISTANCE TO NEAREST: SEPTIC TANK N/a SEWER LINES u/_a.. � DISPOSAL FLO. n/a PROP. LINE BORINGS FOUNDATION AGRICULTURE WELL n/a OTHER WELL n/a PITS/SUMPS --n.La INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 171 industrial LJ Open Bot-.-.m ❑ Manteca Dia. of Well Excavation inc es Dia. of Well Casing n/a ❑ Domestic/Private D Gravel Pack ❑ Tracy Type of Casing nin Specifications I1 Public ❑ Other 171 Delta Depth of Grout Seal zero to 20' Type of Grout concrete/hentor ite 11 Irrigation _.Approx.. Depth I 1 Eastern Surface Seal Installed by drilling contractor r Repair Work Done LJ Type of Pump n/a H.p. n/a State Work Done_ n/a Well Destruction ❑ tAFHtI-Ularnetef 8 inehes Sealing Material (top 501 n/a Depth 20 feet Filler Material (Below 501 n/a TYPE OF SEPTIC WORK: NEW INSTALLATION I ) REPAIR/ADDITION I I DESTRUCTION I 1 INo septic system permitted if public sewer is available within 200 feet.) Installa�n will serve: Residence_ Commercial _ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feev, Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line I LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line N/A I SEEPAGE PITS 11 Depth Size Number SUMPS N/A Ll 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 Local Health District. Home owner or licensed agent's si natuJre certifies the following: "I certify that in the performance of the work for which this permit is issued I shall not fI 9 9 fY pe a employ any person in such manner 35;0 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 sha)l employ persons subject to workman's compensa- tion laws of California." k The applicant must call for all required inspections. Complete drawing on reverse side. --54- �+' �✓ascl d�u C,0',✓/3 Signed K '�' Title: PROJECT GEOLOGIST Date: 12-1 -87 x p/y-7 I FOR DEPARTMENT USE ONLY Application Accepted by Date 14, —2� Area Pit or Grout Inspection by Date Z2_i7Final Inspection by wr/►� Date/ ��& Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Envirorimental Health Permit/Services 1601 E. Hazelton Ave., P.O. BoxSt .rC/� I py FEE AMOUNT DUE I AMOUNT REMITTED RECEIVED BY DATE PERMIT N0. INFO « EH13.24(REV.t/n si FH a-2e �S d o