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SITE 3 :; . SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES . ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209) 468-3420 Q (p w P U BOX 2009, STOCKTON, CA 95201 X::.;6. IpEMIT EXEIRES1 YEAR EROM � amplete in Triplicate) Ap i, n is hereby made,to San J u�i> o ty for a permit to construct and/or install the work herein described. This appli on is made in compliance with San Joaquin County Ordinance No. 549 and 1$62 and the Rules end Regulations of San Joaquin County Public Health Services. Job Address 4' S/O HWY`'4,' 150' W/O SAN JOAQUIN RIVERCity Lot Size/Acreage Owner's Name SPRINT Address 3807 CORONADO AVE. STOCKTON CA phone (209) 941-0917 AMERICAN CONST. & SUPPLY -INCAddress 1038 REDWOOD HWY #2 License No. 310599 >'hone{415) 38108 8 Contractor TYPE OF WELL/PUMP: NEW WELL XX WELL REPLACEMENT 0 DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well [3 DISTANCE TO NEAREST: SEPTIC TANKN/A SEWER LINES N/A DISPOSAL FLD. N/A PROP. LINE N/A FOUNDATION __N7A AGRICULTURE WELL N A OTHER WELL NPITS/SUMPS N/A lNTENDED.LISE TYPE OF%)VELE PROBLEM AREA CONSTRUCTION SPECIFICATIONS .; 2t n Industria! ❑ Open Bottom ❑ Manteca Dia. of Well Excavation � Dia. of Wel! Casing (A Domestic/Private D Gravel Pack 0 Tracy Type of Casing PVC Specifications SCC 40-- -- "I Public X1 Other 1 1 Delta Depth of Grout Seal 50 r Type of Grout 6 SK 3/8" I I Irrigation 1.G9 Approx. Depth I l Eastern Surface Saul Installed by CONCRETE Repair Work Done ,0 Type of Pump NONE H.P. State Work Done _ Wall Destruction ❑ Wel! Diameters 10" Sealing Material & Depth CATHODIC Depth' 100' Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION l I REPAIR/ADDITION I l DESTRUCTION I I (No septic system permitted if public sewer is N/A 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: I Water f'"'@qdepth E." , SEPTIC TANK. ❑ Type/Mfgl Capacity No. CQp;%n1AJE–B PKG. TREATMENT PLT. ❑ Methoieftpirrl Distance to nearest: Wel! Foundation Propeny in L GG ;k'�` StAf�JOAQUIN COUN7Y C ES LEACHING LINE Cl No. & Length of lines N/A Total len9VI v VI g r_I ff r TrrDiviSION FILTER BED C-i Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth _NI/A Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared thisapplication and that the w k.will be done-in•accc-rdance 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 workman's compensa- tion laws of California." The applicant u t call f r al1 required inspections. Complete drawing on reverse side. Signm x STEVE McKIM_ _ Title: PROJECT MANAGER pate: 6/17/93 F R PARTMENT USE ONLY Application Accepted by Date Area Pit or Grout inspection by Date 1 Final Inspection by , Date 7 Additional Commence: Applicant – Return all copies to: San Joaquin County Public Health ! Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., F 0 Box 2009, Stockton, CA 95201 FEE AMOUNT DUE AMOUNT EMITTED CK r1 CEIVED BY DATE $1PJ1 tININFOEH 1321 rR Ev:-+Ix 51 1 •4