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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in.Triplicate) Application in 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 150 North Sinclair City Stockton Lot Size/Acreage30 +Acres Owner's Name Marle Cooling Tower Co. Address 5800 Foxridge Dr-., Mission, KS phone 913 362-1818 I avno 1=nv SPrvirPS Address License No..,6DD469 Phoned - 5 uorl t7 r3c WI�wX-- -* NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well -I TYPE OF WELL/PUMP: PUMP INSTALLATION CX Monitoring Well SYSTEM REPAIR 111)OTHE8 ❑ "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 For FW -2 EW -3 tt Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing -' ` ' [7 Domestic/ Private Gravel Pack C] Tracy Type of Casing_ Specifications A` • 48' X46' Type of Grout feloppt_Rpot 1'1 Public is Other Cl Delta Depth of Grout Seal _ grouting w cement-bentoni t & g 1 Irrigation I _. Approx, 'Depth 1 I Eastern �rund �Os Surface Seal Installed by H.P. State Work Done mdnhol a cover Repair Work Done U Type of Pump Sealing Material 6 Depth 1 t 11 Well Destruction D Well Diameter Depth 95' 1115' _ r rface Filler Material 3 Depth G TYPE OF SEPTIC WORK: NEW INSTALLATION t 1 REPAIRIADDITION I I DESTRUCTION I I alvailabetiw3 st m emitted if public sewer is 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. Compartments PKG. TREATMENT PLT. Cl Method of Disposal l l Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines FILTER BED n Distance to nearest: Well Foundation Total length/size_ Property Line SEEPAGE PITS I I Depth Size Number SUMPS 0 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS. ❑ 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 County j 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 laws of California." Contractor's hiring or sub -contracting signature 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 applicillar7misl call for all re red in ctions. Complete drawing on reverse side. (See Figure 1-1 Signed X Z Title: Date: FOR DEPARTMENT USE ONLY Application Accepted by , Date 7,- 7h Z Area Z Pit or Grout Inspection by Date Final Inspection by "r Date � Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 a EH 13-24 IREV. I/ KS EH 11.28 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH KA RECEIVED BY DATE PERMIT'NO. i 'te cing 1 V'� t