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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)46$--3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES I YEAR FROM DATE ISSUED (Complete in Triplicate) Application 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 1$62 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 855 FLOWERS STREET city STOCKTON Lot Size/Acreage Owners Name TONY CRIVELLO Address 7139 MC CAULEY, VALLEY •.SPRINGS Phone 786-9939 2736. 4500 E. FREMONT ST Contractor NOACK PUMP CO. Address STOCKTON CA 95235 License No. 504513 Phone - TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT DESTRUCTION ❑ Out of Service Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR CX OTHER ❑ Monitoring Well C7 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 Cl Industrial ❑ Open Bottom ❑ Manteca Dia, of Welt Excavation Dia'. of Well Casing X:XDomestic/Private ❑ Gravel Pack x 0 Tracy Type of Casing_ Specifications I'} Public El Other � F1 Delta Depth of Grout Seal Type of Grout I I Irrigation — Approx. Depth I ) Eastern Surface Seal Installed by Repair Work Done POType of Pump H.P:- State Work Done FXTFND WFLL CASING ' Welt Destruction ❑ Well Diameter Sealing Material & Depth ADE AND Depth •" rw. ° Filler Material & Depth _- INST,4L� WELL SEAL, TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I i JNo 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 soli to a depth of-3 feet: Water table depth SEPTIC TANK. O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. El Method of Disposal Distance to nearest: Well Foundation Property.Line, _ E V LEACHING LINE C1 No. & Length of lines Total length/size i FILTER BED n Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that f 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 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 taws of California." Contractor's hiring-or"sub•contracting signature certifies the following: "I certify that in the parlor ante of the work for which this permit is issued, 1 shall employ persons subject to workman's compensa- tion law lifornia." The applicant us call for I r tions. Complete drawing on reverse side. Signed AYL Title: RETAIL SALES D8te: 11 -25-92 FOR DEPARTMENT USE ONLY A-Application Accepted by 4 --- Date - Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY ATE PERMIT'Np. 11 dO X3; 5 EH t4-2a EH 13-24(REV.+i a sl