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APPLICATION RX"VE1 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468--3420 KA JOB APR 2 9 1993 P 0 BOX 2009, STOCKTON, CA 95201 20-1096-*4 17.001 ENVIRONMENTAL HEALTH PERMIT EXPIRES 1 YEAR FROM DATE ISSUED PERMITISERVICES (Complete in Triplicate) Application is hereby made tan Joaquin Countyof r s permit to construct and/or install the Work herein described. This application is made in compliance with Sa Joaqu n County 0}dinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. r__0� Job Address 9900 Block - Overear Cree City Stockton Lot Size/Acreage City of Stockton/ Owner's Name A.O. Spanos Address 1341 W. Robinhood Dr. Phone 478-2200 Contractor Spectrum/Kleinfelder Address 2825 E. Myrtle St. License 0.12268 Phone 948-1345 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION Ct9rrta�'8arvtetir'rt {-} PUMP INSTALLATION El SYSTEM REPAIR ❑ OTHER U men42 Wol3 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. pltCf'. . 4 borings FOUNDATION AGRICULTURE WELL OTHER WELL prM7StvWp5• 40-60' dee i ac fill with INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS hole plub O Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation D Jr.-b?0M-C3ZtRT 1-1 Domestic/Private ❑ Gravel Pack7 ❑ Tracy Type of Casing— Specification V1 Public (-1 Other f-1 Delta Depth of Grout Seal TMV-01-6 trt I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done L3 Type of Pump H.P. _� State Work Done Wail Destruction ❑ Well Diameter Sealing Material & Depth Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION l I lNo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Charactef of soil to a depth of 3 feel: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Sire Number SUMPS LI 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 Home owner or licensed agent'a 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 became subject to workman's compensation laws of California." Contractors hiring or sub-contracting signature certifies the following: "f 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 Callfa The applicant ca or I requi ed s mplete drawing on reverse side. Signed �- Title: Senior Engineer Date. 4-28-93 F ARTMENT USE ONLY Application Accepted by Date Area Pit or Grout inspection by Date Final Inspection by>a44i&1Date 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 FEE INFO AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. . EH13.24{t1EV. n S! S S r e� l '�� T �7 j—[J l EH H•Is