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-RECEIVED <br /> IRONMEN�AALIH <br /> _ (Complete in Triplicate) <br /> 1�plication is hereby aa�de to t3aa Joaquin County for a permit to construct aod/or install the trotk herein described. This <br /> AN11eation ill wade in oottbliance vith Sats Joaquin County Ordinance No. 549 and 1862 sad the Rules &W Regulations or San <br /> Joaquin County Public Health ow-vices. <br /> 07.3 0:3$ � I: <br /> Pacif'ic�Ave /Wi l lora <br /> Jab Addraea: City Stockton Lot Size/Acreage <br /> Unocal 2000 Crow Canyon. cP, . <br /> Pla ,, <br /> Owner's Nems Addrou - _ Phone - — <br /> i San Ramon, CA 94583 <br /> Contractor Paradiso Constructionpddres5 2600 Williams St.. San LeL31t1AgiFNo. 7.59820 phone51-0-614-83 <br /> TYPE Of WELLJPUMPI NEW WELL 0 WELL REPLACEMENT r DESTRUCTION 0 Out or aorvice afoul <br /> PUMP INSTALLATION 0 SYSTEM REPAIR C7 OTHER 0 Monitoring Well p <br /> J DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO.- -.. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PIT$/SUMP'$ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> n Industrial ©Open Bottom 0 Manteca Dip. of Weed Excavation Die, of Well Casing <br /> n Domestic/Private 0 Gravel Pack 0 Tracy Type of Casing_ S <br /> I'I Public n Other n Nita Death or Grout $eal TYpe of Grout1—_ <br /> I i Irrigation —.Approx. Depth I I Eastern Surface Seat Installed by <br /> Repair Work Done v Type of Pump H.P. State Work Done�. <br /> Wall Destruction O WON Olamptar _Seeding Materiel i riepth <br /> Depth I biller Material S Depth <br /> VrP bP 3EFTrZ inrOAK; irtw OV0ALL^Jtvn i t NUFAIM1^1JUIi1UN , i UPbtHULttury "i fNo legal system rmgtad n Publicsewer is. <br /> } evallawo within 2�faet.l <br /> Instellotian will a": ReaWonce Commercial_ Other Our work at above mentioned site, <br /> Number of IMM units Number of bedrooms consists solely with the elimination o <br /> Character of soil to a depth of 3 feet# e x i:s t i n s e •`t i y e t ern. "" a <br /> SEPTIC TANtt. d Typ./hits. Capacity - No. Compannoras <br /> PKO. TREATMENT PLT.0 � � Method of Disposal <br /> Distance:to nearest:- Wall F <br /> � otsndation Property Lino <br /> LEACHING LINE ❑ No. E Lenflth of linos _ ` Total length/sisa <br /> FILTER BID 0 ,Distance,s o nearest; Wee Foundation Y Property Line <br /> SEEPAGE PIT$ I I Depth slue Numbly <br /> SUMPS LI Ditaff a tD 1+aat"ll: Well Foundatio,► __ Property Lina <br /> DISPOSAL PONDS <br /> I hereby certify that I have prepared this applicalion and that the work will be done- in accordance with San Joaquin county ordinances,slats taws, a <br /> rules arta regulation of the $an Joaquin Coaaty <br /> 04o1M owner or licensed agent's e-}pnature*"fin the foHawinp; "I oaring that In the Performance of the work for Which this permit li iaauad,I*0411 rw <br /> employ any person In such manner as to become subject to workman's compensation laws of Caldornis," Contractor's hiring or sub-contracting itlgnetUre <br /> eLnifiee fire following; "I comely that In the perforMflrnce of the work for which this permit is issued, I*hall employ persons subject to workow's compensa. <br /> tion taws w Callfor ie-.'• <br /> The appheont I call for all ired pscttons. Complete drawing on reverse side. <br /> 8iarNd •--''1/ Title: Vice-President 10/14/92 <br /> rlc. Mont sand ""— Dote- <br /> FOR DEPARTMENT USE ONLY C� <br /> Application Accepted by Data ���� a��J�✓ Area 15PA' <br /> Pit or Grout Inspection by Date Final Inspee' n by Data <br /> Additional Cotrinwn: `4" DSL �S <br /> f <br /> Applicant - Return a12 eopies to: San Joaquin county P io Health Services <br /> Environmental Health Permit/Services <br /> 445 N bap Joaquin, P O Box 2009, Stkn, OA 95201 <br /> INFO AMOUNT DUE ; AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. <br /> 1 <br /> eN ittev., u, <br /> % Z7�Yt IO�Z qZ X17.. �� <br /> EK ts•X <br />