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` -x-i,.LCATION SiVO�JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3 �1 t1:J�. P O BOX 2009, STOCKTON, CA 95201 ff�fjjjj LL��Lui PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) iAR 2 .`'-' 1994 Application is hereby sade,to San Joaquin County for a permit to construct and/or ins rein described. This application Is made in coaPliance with San Joaquin County Ordinance No. 549 and 1862 ins", � f=mss of San Joaquin County Public wealth services. I rein Job Address City of Stockton R.O.W. ( 133 W HA CIIJ ng, Stkn lot size/Acreage (for 140 West Harding Way) Owner's Name City of Stockton Address DP-Pt- of Public WCIrka Phone 3241 Fitzgerald Rd. , #2 contractor GeoAudit/Turner Exddress—_Rancho Cordnva 9S74,2:ense No.Lix2_7.2.0—_Phoma ( 916 )852- 454 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR O OTHER ❑ Monitoring Well W DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER LINES 3 A r DISPOSAL FLO. N/A PROP. LINE 5 r FOUNDATION ---LO—' AGRICULTURE WELL N A OTHER WELL-B-/-A— PITS/SUMPS NLA INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C7 Industrial • ❑ Open Bottom ❑ Manteca pia. of Wall Excavation Dia. of Well Casing 2, Domestic/Private Z}(Gravel Pack ❑ Tracy Type of Casing PVC Sch. 40 . Specifications I.1 Public n Other I7 Delta Depth of Grout Seal 41 ' Type of Grout Portland C men I Irrigation _Approx. Depth- q Eastern Surface Seal Installed by H. grey Well cover Repair Work Done U Type of Pump H.P. - State Work Done - Well Destruction ❑ WON Diameterea Sling Material • Depth bentonite Depth Filler Material i Depth mon t o re y s and #3, 4 3-6 0' TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system psrmitted 11 public sewer is available within T , Installotion win serve: Residence_ Commercial_ Other Nuof living units: Number of bedrooms Chaaoter a to a 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 ❑ No. enpth of lines al length/sae FILTER BED istance to nearest: Wall Foundation Lina SEEPAGE I ! Depth Sae Number SUM LI Distance to nearest: Wen Foundation Property Line DISPOSAL PONDS ❑ 1 hersby certify that I haw Prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and npulations of the San Joaquin county Homo owner or licensed ap m,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.,,Contractors hiring or sub•tontractatp signature tion levee of� I MUNI;Ow following: certify that m tM performance of the work for which this permit is issued, I shall employ persons subject to workman's comtpwm- The applicant call ed inspmt . Complete drawing on reverse side. Signa Title: Project manager Date: 3-22-94 FOR DEPARTMENT USE ONLY Application Accepted by Date 2 Area t/- L:6.15 Pit or Grout Inspection by Datsa a Q Final Inspection byAdditional Comments:Applicant - Retur 11 cop es to: San J n C6ttntfb cea hSe�445 N San Jo BialHealP permit/Services445 N Sora Joaquin, P O Box 2009, Stkn, CA 85201 FEE AMOUNT DUE AMOUNT REMITTED KRECEIVED f!VINFO CASH DATE PERMIT•N EMt>24LIIEV.IiR51 •oa .oa ^a� sZge EN 1471