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APPLICATION FOR PERMIT SAN JO•IN COUNTY PUBLIC HEALTH SER0110ES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FRQM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or ins tall 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 38 West Sonora St. (Morton Paint Company) City Stockton Lot Size/Acreage 1 acre Owner's Name Pacific Gas & Electric Address One California Street Phone(415) 972-1116 Attn: Yvonne Meeks San Francisco, CA 94106 Contractor Spectrum Exploration Address 2825 Myrtle St. Stocktopicense No. 512268 TYPE OF WELL/PUMP: NEW WELL 0 WELL REPLACEMENT 0 DESTRUCTION 0 OutPofnSerOvice W 118 02 PUMP INSTALLATION 0 SYSTEM REPAIR 0 OTHER ]n Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 2 Boreholes SEWER LINES 50 t DISPOSAL FLD. PROP. LINE —�8 t See Map FOUNDATION " 101 AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial 0 Open Bottom ❑ Manteca Dia. of Well Excavation D Domestic/Private ❑ Gravel Pack Dia. of Well Casing ❑ Tracy Type of Casing g Attached L` (1 Public (7 Other (l Delta Depth of Grout Seal Specifications I I Im ation Type of Grout 1 0 _Approx. Depth I I Eastern Surface Soul Installed by U Repair Work Done LJ T 1 ype of Pump H.P. State Work Done _ V Neil Destruction ❑ e Diameter 10 inches Sealing Material i Depth Cement grow o 40 t (B19, B20) Borehole Depth 40 feet Filler Material a Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 1 1 DESTRUC71UN I I fNo septic system permitted it public sewer is Installation will serve: Residence_ available within 200 feet.) Commercial _ Other Number of living units: _ Number of bedrooms Character of coil to a depth of 3 feet: SEPTIC TANK Water table depth ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines FILTER BEDTotal length/size CI Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Sire SUMPSNumber LI Distance to nearest: Well Foundation DISPOSAL PONDS 0 Property Line 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin coun rules and regulations of the San Joaquin County ty ordinances, state laws, and 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 applicant st call for all required 'ns sections. Complete drawing on reverse side. //'' e Signed Xti/) D� FT 0 n Title: ? ��Ay I J� —'� ., Date2.1 : � 1^- Y•�y��in FOR DEPARTMENT USE ONLY Application Accepted by -- 4. � —G f Data ll —// AreaPit J d it Grout Inspection by L NQ Z Inspection by Date Additional Comnronta: Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services _ 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE gMOUNT DUE AMOUNT REMITTEDF��CASHRECEIVE INFO D BV DATE PERMnNO.EM tYb IREV.vxv �� EH 11.16 1 rO� a ` LI (�' 3� ll-