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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 KA JOB 20-3574-01 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) DSS--070--7-t Application is hereby trade 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. 544 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. APN .#055-070-14 GRAIN STORAGE TANKS ,4H1 mwAy n-,-WEST OF I-5 City Lot Size/Acreage Job Address - -- fa,040-e Owner's Name STe*tf i 1" SCJC/V KLEIN BROS. LTD. Address 1305 W.FREMONT ST. ,STOCKTON Phone J Contractor Spectrum/Kleinfelder Address 2825 E. Myrtle Street License No. 512268 Phone 948-1345 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT C} DESTRUCTION -0�+>- & +�*�—� PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER IN tvlet . er�apl."bisa,>~ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. Pner7t:ttle 3_Test Bor'ngs FOUNDATION AGRICULTURE WELL OTHER WELL P4+f81ifefPS- 201-401 De p Dia INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS No GW N �.. CJ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation anticipated `pv D Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing_ iO1s If GW I'l Public 1-3 Other . 11 Delta Depth of Grout Seal TYPa Q�G t I i Irrigation _,Approx. Depth I I Eastern Surface Seal installed by encountered,will e Repair Work Done 0 Type of Pump H,P. State Work Done backfill with + Well Destruction ❑ Well Diameter Sealing Material S Depth "hole plug" T: t Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.l i 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. Gl Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED EJ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number f•_ SUMPS Lt Distance to nearest: Well Foundation Property Line N! 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 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 Wlowin "1 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 Califo a ' The applicant s at o uired in )WO plete drawing on reverse side. Signed X �• Title: Project Engineer Date: 3-19-92 EQ"EPARTMENT USE ONLY Application Accepted by Date_,_ -^`�`Z Area � SAb Bdtte��6S AP Pit or Grout Inspection by Date Final Inspection by No Eve DtEfGE �f;,1.ihJ Additional Comments: At rc� Applicant - Return all copies to: San'Joaquin County Public Health Services u aEV41a.� Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 .� FEE INFO AMOUNT DUE AMOUNT'.�iEMrTTED CASK RECEIVED BY DATE PERMIT NO. . EM 13-24TREY.I/A W 5-%1 b12- EH 4-2e tttJJJ LIIJJJ