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�— APPLICATION SAN JO!QUIN COUNTY PUBLIC HEALTH SOICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 5-6 soil borings to 14' 00?lPERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made,to Sm Joaquin County for a permit to construct and/or install the work herein described. This application Is made in compliance with Sm Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Sm Joaquin County Public Health Services. Job Address 3535 Cherokee Road city Stockton Lot size/acreage Owner's Name Delta Truck Sales Address Same Phone 209-466-4161 Contractor Beylik Drilling Address 3429 Longview Dr,N. Higt ]Wms, o. C57-306291 Phone916-485-0792 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER a Monitoring Well soil borings to T5'5 DISTANCE TO NEAREST: SEPTIC TANK 100, SEWER LINES 100' DISPOSAL FLO. 100' PROP. LINE cn' FOUNDATION 100, AGRICULTURE WELL 100' OTHER WELL NA.._ PITS/sumps NA-_ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial Cl Open Bottom ❑ Manteca Dia. of Well Excavation Oia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications 1'1 Public ❑ Other r Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx. Depth 1 I Eastern Surface Seel Installed by Repair Work Done U Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material L Depth Depth Filler Material L Depth Bentonite Hole Plug TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 1 I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 lead I t\ Installation will some: 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.❑ Method of Disposal Distance to nearest: Well Foundation Property Line finn— li LEACHING LINE ❑ No. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Properly 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's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 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 comity 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 a iplican st call f all r iced inapt, do 6. Complete drawing on reverse side. Signed X Title: Date: 2.5- Paul K. Graff r Sr. Project UeOiOgist F DEPA T NT USE ONLY Application Accepted by Date a y 3 3 Pit or Grout Inspection by Data Final Inspection b Oats Additional Comments: Applicant - Return all copies to: San Joaquin EnviroomentaloHealth unty uPermit blic Health vices /Services 445 Ni San Joaquin, P O Box 2009, Stkn, CA 95201 77 .7cJ FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. INFO ?7 � �y��( G/► p/�c�r . EN 1324 IREV.rr x al , I �2-0 d V �i • %I/`-'� EN Ib2a