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` APPLICATION FOR PERM I T SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 P O BOR 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 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 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 8950 N Alpine Road City Stockton Lot Size/Acreage Owner's Name F&S Solari Address 9122 N Alpine Road Phone 1.-204 Contractor Clark Well Address 2024 E Charter Way License No. 371.560 Phone 462-7676 TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT O DESTRUCTION O Out of Service Well O PUMP INSTALLATION O SYSTEM REPAIR 19 OTHER O Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial O,Open Bottom O Manteca Dia. of Well Excavation Dia. of Well Casing [I Domestic/Private 0 Gravel Pack O Tracy Type of Casing Specifications I"I Public [I.Other n Delta Depth of Grout Seal Type of Grout I I Irrigation Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done N Type of Pump H.P. S ale WRq,,rk Done Raise Casing O Well Destruction O Well Diameter Sealing Material & Depth above Rround ievel. Depth Filler Material & 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: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. O Method of Disposal Distance to nearest: Well Fo4ndation Property Line LEACHING LINE CI No. & Length of lines Total length/size FILTER BED O Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size _ Number Its- SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O -- - _ I hereby certthahave prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules end re ul ionstI of the an Joaquin County Home owne or licensed a n s signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall note employ any r on in suc ma er as to becom ubject to orkman's compensation laws of California." Contractor's hiring or subcontracting signature certifies the fol ing: "I c rtify he in the r ante of work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of C lif rnia." The applies s ca or,�Ir d in ct s. m drawing on reverse side. III Signed Title: Sec-Tres Date: 11 July 90 FO DEPARTMENT USE ONLY Application Accepted byL Date Area _ Pit or Grout Inspection by Date Final Inspection by Date_1.�131/n Additional Comments: I 1 Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services EE 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 IN AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMI7'N0. + EH 13.24IREV."5) 7 J/ a ]��; /�`�/� �D„/7 EH'11.26 v L C