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A_DPL-IC.1TTM • 3 Soil Borings w/Hydropunch SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application 1s hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance vlth 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 Spectrum Address 2825 Myrtle, Stockton License No. 512268 phone 465-8712 TYPE OF WELL/PUMP: NEW WELL.0 WELL REPLACEMENT Ci DESTRUCTION q out of Service 4ela 0 PUMP INSTALLATION O SYSTEM REPAIR 0 OTHER ' Monitoring Me11 0 ',C Soil Borings DISTANCE TO NEAREST: SEPTIC TANK .SEWER LINES DISPOSAL FLO. PROP. LINE — FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS - tNTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS q Industrial O Open Bottom 0 Manteca Dia. of Well Excavation Dia. of Well Casing Domestic/Private 0 Gravel Pack 0 Tracy Type of Casing Specifications I'1 Public 0 Other fl Delta Depth of Grout Seal Type of Grout r I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by (/ Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction 0 Well Diameter Sealing Material L Depth �p Depth Filler Material L Depth �V a mPnt/hentnnite 10' - 251 V TYPE OF SEPTIC WORK. NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted it public sewer is available within 200 fest.) Installation will serve: Residence_ Commercial _ Other Number of living units: _ Number of bedrooms p( Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments 1 PKG. TREATMENT PLT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. 6 Length of lines Total length/size FILTER.BED - 0 Distance to nearest: Well Foundation Property Line _ SEEPAGE PITS I I Depth - Size Number SUMPS LI Distance to nearest: Well Foundation - Property Line DISPOSAL PONDS 0 1 hereby comity that I have prepared this application and that the work will he 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." Contractols 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 law.of dor 'a." The applic t must all for r uir inspections. Complete drawing on reverse side. Signed Title:_C� Date: FOR DEPARTMENT USE ONLY Application Ac eptad by k1l` , Date -IS'qJ Area Pit or Grout Inspection by Sklkd O.'.\. �W Date Final Inspection by Data Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Boz 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED aY DATE PERMIT'No. INFO f� !��''r^w� CASH r . EM 1124(REV.ir+s)Lll\ �IA/ aA 4,11,h1/ 61.01 �•11 UYn 1tYfV..