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#j APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH VICES 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 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 vith San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address, 1014 N. El Dorado St . city Stockton Lot size/Acreage 1/8 ac . owners Name .Budget Rent-A-Car_ Cor„Qdress 200 N. Michigan Ave . Phone 312-408-6637 Chicago, Illinois " Contractor �� 'f Address. License No. Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 17 DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR 0 OTHER CICStor1toring Well [3I �3oinch DISTANCE TO NEAREST: SEPTIC TANK _n/a SEWER LINES 50 r DISPOSAL FLO. n/a PROP. LINE ZQ_ k FOUNDATION 20 ' AGRICULTURE WELL n a OTHER WELL n a PITS/SUMPS -g,/a INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing [:1 Domestic/Private ❑ Gravel Pack7 ❑ Tracy Type of Casing_ n/a Specifications I'3 Public i'l Other t M Delta Depth of Grout Seal 20 ' Type of Grout neat ceme 'It I I Irrigation _Approx. Depth IXEastern Surface Seal Installed by Repair Work Done U Type of Pump H,P. State Work Done k Well Destruction ❑ Well Diameter Sealing !Material i Depth � Depth 20 ' Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIWADDITION I 1 DESTRUCTION I I lNo septic system permitted if public sewer is ~ available within 200 feet.) ' Installation will serve: Residence— Commercial— ❑ttrsr 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. 0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE C1 No. B Length of lines Total length/size �- i FILTER BED ❑ Distance to nearest: Well Foundation Property Line I SEEPAGE PITS ( I 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 iignature 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 su:h manner as to become subject to workman's compensation laws of California." Contractor's 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 laws of Cal'ornia." The applicant ust c I for al ired inspections. Complete drawing oAA�Z� erse side w • I � 1 Signed Title: Date: FOR DEPARTMEhq USED LY yq �•[' (� Application Accepted by Date 3-�� Area Pit or Grout Inspection by Date Final Inspection by Date Additional Commenu: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2005, Stkn, CA 95201 FEEINFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY GATE PERMIT NO. tH,a't.rnEv.,,r+sr 9pd c�l Z �1•�.� EN 1420 �