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5 Soil Borings ApPLIC4T?O*I To 15 Feet SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install 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 15135 W Eight Mile Rd _ _ City Stockton Lot Size/Acreage Owner's Name Herman & Helens Marina Address 15135 W Eight Mile Rd. Phone 951-4634 Contractor Vironex Address Foster City License N0.705927 Phone800-847-6639 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well LI PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 6 Soifl BoringSWell C3 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications I'I Public ❑ Other P Delta Depth of Grout Seal Type of Grout- 11 routI1 Irrigation _APprox. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Filler Material i Depth(leat C anent Z4% Be Ii on i t e TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION ( I DESTRUCTION I I (No Nailabetic syste shin 200 leetifed if public sewer is Installation will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of soil to a depth or 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 LEACHING LINE ❑ No. i 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 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'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 follo ' "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 dornia.' The applican must call or all rfquir d i (spgctions. Complete drawing on reverse side. Signed s Title: Geologist Date: 8/22/96 7 FOR DEPARTMENT USE ONLY Application Au ted by 1 r Data I Area Pit or Grout Inspection by Date Final Inspection by Dace 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 r�F E AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMITNO. /1fH1324 IREV.i r x S) �� Iz n