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ii !� APPLICATION-FOR PERMIT �I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone (209) 466-6781 II PERMIT EXPIRES 1'YEAR FROM DATE ISS I � � r � !! (Complete in Triplicate) M /; Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein desci�d s application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and ttON-e'er Regulatio a San Joaquin Local Health District �r vv CGr ((ff1,989 it tN vir Job Address 942 S. Stockton Avenue Ripon p�Q 'PVT r City PM '� RLJ�CES try Owner's Name Simpson Paper Co, 1 Address P.O. Box 757, Ripon, CA Phone 209 599-4241 ii. P.O. Box 50367 (415) Contractor Pitcher Drilling Address Palo Alto, CA 94303 License No. 263085 Phone 328-8910 TYPE OF WELL/PUMP: 'NEW WELL F M-11C WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 50 SEWER LINES 7 50' DISPOSAL FLD. NA PROP. LINE}50 r FOUNDATION ;�' 501 AGRICULTURE WELL NA OTHER WELL 10 r PITS/SUMPS NA I INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFI _ NS ��TIQ -'- 5 inch ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well ExcavationDia. of Well Casing El Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing P Specifications F] Public IX Other MOnitorilfg Delta Depth of Grout Seal 150' Type of Grout Cement Bent I i Irrigation 180}Approx. Depth i I Eastern Surface Seal Installed by Pitcher u Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Fillet Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIR/ADDITION I 1 DESTRUCTION I I (No septic system permitted if public sewer is r available within 200 feet.) t`) Installation will serve: Residence_ Commercial_ Other 1� 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. ❑ �! Method of Disposal Distance to nearest: Well Foundation Property Line 0 I! LEACHING LINE ❑ No. & Length of lines Total Iengthlsize FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS l I Depth Size Number SUMPS 0 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 19' 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 Diltrict. 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." li The applicant must calf for all required inspections. Complete drawing on reverse side. II Signed X Title: Plant Manager Date: ,>x--f Jr-1t9_- � II F EP ENT USE ONLY Application Accepted by Date Area Pit or Grout Inspection by Dat e�Yvl Final Inspection by' Dale3- I� Additional Comments:' ❑ Stk 466.6781 ❑ Lodi, 369-3621 ❑ Manteca 823-7104 0 Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 il ih FEE AMOUNT DUE AMOUNT RE_MITTE6 RECEIVED BY DATE PERMIT'NO. INFO C Ilr �.£H 13-24(REV.I i n sf ""—/r EH 14-2e 1 Appl.l.cant is Nestle Foods Corporation, Owner is Simpson Paper Co. Agreement is atZa-elted.s�!