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f. APPLICATION FOR PERMITi 406 AN JOAQUIN LOCAL HEALTH DISTRInNpsol E• H ephohe 2091 466 6 81 ZELTON AVE., TON, c9 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED S�� pL�1� (Complete in Triplicate) E�vPERM1IT J SERVICES Application is hereby made to the San Joaquin Local Health District 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 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 540 W. Scotts Avenue City Stockton Lot Size PM Owner's Name Acme Galvanizing Co. Address 1655 - 17th Street Phone A7 90 - Oakland , CA C6f CS�J Anaheim, CA 501384 Contractor I n te r s t a t e Soil Sam lltligess 542 Atcflinson . NXttX3tf(Df License No. Phone 772- TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ® monitoring well 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 ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 10" Dia. of Well Casing 4" Cl Domestic/Private N Gravel Pack ❑ Tracy Type of Casing 4° d is pyid Specifications 1-1 Public ❑ Other F1 Delta Depth of Grout Seal 0-201 Type of Grout__2--_s:- c,k_sl u r_ny I I Irrigation 4k Approx. Depth I I Eastern Surface Seal Installed by H yd r o t e c h Co n s u I t a n t c _ Repair Work Done ❑ Type of Pump x H.P. State Work Done —1 0_L L88 Well Destruction Ct Well Diameter _x Sealing Material Stop 501 Depth x Filler Material (Below 501 Q TYPE OF SEPTIC WORK: NEW INSTALLATION I'] REPAIR/ADDITION l 1 DESTRUCTION 1 I (No 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 ❑ Type/Mfg Capacity No. Compartment n PKG. TREATMENT PLT. ❑ Method of Dispooke t, Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size ,`' 1-314 4 ALQFILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line Q DISPOSAL PONDS © Z � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state taws, and rules and regulations of the San Joaquin Local Health District. Home owner or licensed agent's signature certifies the following: 1 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 S 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 m all for all required inspections. Complete drawing on reverse side. Signed X Title: Pro ect Geo 1ngist Date: .. _9122(88 Ant ony Saponara FOR DEPARTMENT USE ONLY Application Accepted by Date f 1 I�0 U Area Pit or Grout Inspection by Date Final Inspection by Date LL- Additional Comments: ❑ Silk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED INFO RECEIVED BY DATE PERMIT NO. r.EH 13-24(REV.1/s 51 EH 14-26 • S) �