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n.c uiCATION -led SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION OPY 445 N SAN JOAQUIN, PHONE (209)468-34 n'g 1 P O BOX 2009, STOCKTON, CA 95201 PMWIT EXPIRES 1 YEAR FSOIt DATE IS -"M )QR 2 (Complete in Triplicate) 1994 Application is hereby made,to Ban Joaquin -County for a permit to construct and/or ins n described. This application is aside in cagllance with Ban Joaquin County Ordinance No. 549 and 1862 and �a '�ns of San Joaquin County Public Health Services. I ERVICES JobAddrea City of Stockton R.O.W. ( 133 W_ , Heading, fiticn _got Size/Acreage ( for 140 West Harding Way) ------- Owner's Name City of Stockton Address Dept - of Plibl i c Works Phone 3241 Fitzgerald Rd. , #2 Contractor GeoAudit/Turner Emdmss Ranches Cordnva RSM4.Zense No. 6,6,2720 Phone 916 852- J 454 TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT O DESTRUCTION O Out of Service Well PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well M DISTANCE TO NEAREST: SEPTIC TANKSEWER LINES 30 t DISPOSAL FLO. N/A PROP. LINE 5 t FOUNDATION 161 AGRICULTURE WELL N A OTHER WELL NL— PITS/SUMPS NL.� INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C7 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 2 s Of . 40 Domestic/Private �GravM Pack PVC Sch ❑ Tracy Type of Casing Specifications D Other I 41 ' Wo of Grout Portland c er '1 Ptrblic ('1 flDelta Depth of Grout Seal T I I Irrigation _Approx. Depth_ 4 Eastern Surface Seal Installed by lush grey Well cover Repair Work Done LJ Type of PumpH.P. State Work Done � Well DrtutitIn ❑ Well Diameter �— Sealing Material i Depth bentonite ,-71-431 Depth Filler Material & Depth montere y sand #3,, 43-601 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 2 Installation will serve: Residence_-_- Commercial_ Other of Crying tmitss Number of bedrooms Charaeaof it tc s depth of 3 fest: water table depth SEPTIC TANK Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Foundation Property Line LEACHING LINE Cl �No. ngth of lines I length/size FILTER BED newest: Well Foundation Lina SEEPAGE I I Depth Size Number SUM LI Distance to newest: Well Foundation Property Line DISPOSAL PENDS ❑ 1 hereby certify that I have prepared the 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 agatYs signature certifies the following: "I certify that in the performance of the work for which this permit is issued. I shell not smpioy any person in such manner as to become subject.to workman's compensation laws of California.'•Contnetot's hiring or sub-contracting signature certifies the following:"1 certify that in the performance of the work for which this permit is issued, I,hall employ persons subject to workman's compensa- tion laws of California." The applicant call ad insp" . Complete drawing on reverse side. Signed Title Project manager Date: 3-22-94 FOR DEPARTMENT USE ONLY Application Accepted by 4 - Date Area Pit or Grout Inspection by Date Final Inspection by Dae Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services ` O Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 IEEE AMOUNT DUE AMOUNT REMITTED CK 8 CASH RECEIVED BY DATE PERMIT'No. rM 14111