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1 ..-._.�_.— .... .-.. .. _ .- :...4,., .r.l....•[rL vaZ....v s....�... _., . .k YC3..ter_—......___ . . .li:�., a. APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON. CA Telephone (209) 466•6'181 I PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District tot a permit to construct a6d/or install the work herein described. Thie pp it is Local Health District. \\ made in compliance with San Joaquin County Ordinance No. 549 for sewage or Wo. 1862 for we1�lpump and the Rules and Regulations of the San Joaquin I 6425 Pacific Avenue r , .lob Address �. City Stockton Lot Size 244 X260 PM Owner'sl Wickland Oil Company Address 1765 41alleMp Way. Sal=anentA, CA 9581�hon.(916) 921-1100 NAr Contractor Western G90 ftltgi� Address 1386 E. Isatler St License No. 513857 Phone (916) 662-.4541 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ®M!lrl}too.Wall DISTANCE TO NEAREST: SEPTIC TANK N A SEWER LINES _ DISPOSAL FLD. N A PROP. 'LINE -N/— _50' A FOUNDATION N/A AGRICULTURE WELL, N/A_ OTHER WELL N A .1'1TS/S + P$ N/A INTENDED USE TYPE OF WELL PROBLEM AREA %CONSTRUCTION SPECIFICATIONS ❑ Endustrial El Open Bottom ❑ Manteca Dia. of Well Excavation_ 0" Dia. of Well Casing.. 4" ❑ Domestic/Private R Gravel Pack 0 Tracy Typb of Casing PVC Specifications f-1 Public i-1 Other W Delta Depth of Grout Seal Type of Grout T1eat C>3tlr=l t I I irrigation 65±Approx, Depth I I Eastern Surface Seal Installed by--- W'SSd'C33 _ Repair Work Done L] Type of Pump NIA H.P. State Work Done – Well Destruction ❑ Weil Diameter " Sealing Material stop 501 Eet =t Depth 65, Filler Material (Below 50'1 ___#3 Dim ,l=-a_- 1r' TYPIE OF SEPTIC WORK: NEW INSTALLATION I i REPAIR/,ADDITION.I I DESTRUCTION € I lNo septic system permitted if public sewer its Installation will serve: Residence Commercial available within 200 feet.) N OtherLA Number of living units: Number of bedrooms Characteiiof soil to a depth of 3 feet: Water table depth SEPTIC TANK L1 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Di Disposal Distance to nearest: Well• Foundation Property Line LEACHING LINE Ll No. & Length of lines Total fength/size FILTER BED LI Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS l_I Distance to nearest: Well Foundation Property Line DISPOSAL PONDS I] , 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 Dr3trici. 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 shalt not employ any person in such manner as to become subject to workman's compensation laws of California,"Contractors hiring or sub t iss ed,ting signature certifies the following: "f certify that in the pertormance of the work for which this permit is issued,I shall employ persons subject to workman's compensa- tion laws of California." The applicant m t call for all to 'ad inspections. Complete drawing on reverse side. I SignedGborW Title: PIT�91rEl7t Date: 1/11/89 verse FOR DEPARTMENT USE ONLY Application Accepted by Date V / Area Pit or Grout Inspection by Date '21 Final Inspection by Dates Additional Comments: .5 Stk 466.6781 ❑ Lodi 369-3621 O Manteca 823-7104 ❑ Tracy 835-6385 ppllcant - Return all copies To: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUEAMOUNT REMITTED CK INFO CASH RECEIVED BY DATE PERMIT'NO.