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� n spa <br /> h '1 <br /> m. <br /> t.r•r'LIL:HIIDN }•[)H tLhir�tr <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 16UI E. IiA7CLTON AVF„ STOCKTON. CA <br /> Toltnihono (209) 4&6.6781 <br /> PERMIT EXPIRES l YEAR FROM DATE ISSUED <br /> (Cornpleia In TripflCille) <br /> rAtk <br /> haitibY <br /> with San Jotts aquin County rl.Otd nalHealth nLo Nu,4'9 rtat towage o permit <br /> No IB62 for we 1ldpump ainstall <br /> nd ine Rules end iRegusa.ons of This <br /> San Jo+« <br /> Local Health District. <br /> 642.5 Pacific AVn-nU0 Stockton Lot Sita 240'X2600 PM <br /> Job Address - - —�--' CdY <br /> Wickland Oil Company Address 1765 challengeVZq, tO' CA 9581�hona(916) 921-1100 <br /> Owner's Name - - <br /> License No.513857 (916) 662--4 <br /> y�str�t Gen ESx1ireers _Address 1386 E. Fi�a1�r StPhone <br /> Contraclar - <br /> TYPE OF WELLlPUMP; NEW WELL 0 WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> EM REPAIR ❑ OTHER ®knit=- khu <br /> PUMP INSTALLATION ❑ SYST <br /> DISTANCE TO NEAREST: SF,PTIC TANK .NIA SEWER LINES 50, ' DISPOSAL FLD. N A POOP. LINE N A <br /> FOUNDATION _ N�-A AGRICULTURE WELL NLA_ OTHER WELL N/A PITS15 PSMA <br /> INTENDED USE TYPE OF WELL PROBLEM AREA %CONSTRUCTION SPECIFICATIONS 4 <br /> >]Industrial tT Open Bottom []Manteca Dia.of Well Excavation 10" Da.or Wall Ctsiny <br /> Gravel Pack Ci Tracy Typta of Casing PV<. Specifications <br /> ❑ DomstielPtivata 52 Type or Groot <br /> 171 Public <br /> 1-1 Other F2 Delta Depth of Grout Seal <br /> I I IrnOatron <br /> �5~Approx, Depth I I Eastarn Surface Saul Installed by- NMtern C'M' LD0aM <br /> H.P.- State Work Dona <br /> Repair Wart, Dune U Type of Pump <br /> Well Destruction 0Welt Diameter _ a„ Sealing Material Ilop 561 <br /> Depth <br /> (,5 Filler Material[Below 501 <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION# I I IR1p.DD#TION! I OL57RUCTIO-V I I INcteptic sys?l hit m poi trttod if P;)w4 sewer ts <br /> avj�lInstallation w111 serve: Residence.—. <br /> Commarclai— Ot'iet <br /> Number of living units:._^ Number of bedrooms <br /> Wates tali;6 depth <br /> Characreiof sod to a depth of 3 feet-. No.Campartman[s <br /> SEPTIC TANK U TypalMfJ Capacity <br /> Method of Disposal <br /> PKG,TREATMENT PLT.❑ Property Line <br /> Distance to pearesr: Well_ Faundat+an Pe y <br /> Total length/size_. <br /> M-ACHING LINE Cl Na.d Length of lines _�— -- <br /> FILTER BED CJ Distance to nearest: Wail Foundation Property Lira <br /> Number <br /> SEEPAGE PITS 11 Depth _ --Sita Property rine <br /> SUMPS LI Distance to nearest: LVe!! Foundation <br /> DISPOSAL PONDS n _ <br /> I hereby certify that I have pi9pared this application and that the work wrtl be done in accordance with San Joaquir county ordinances,state law <br /> rules and regulanorty of the San Joaquin Locat Heaah D3tricl. <br /> Home owner or licensed agent's signature Certifies;he tollowinq:"I certify that in the parlormance of the work for w och this permit is issued,I sh <br /> employ any person in such manna•as to become subject to workman's comperda; sig <br /> tir.ns vl California.Coliforna."Contractors hiring or autrcontrectin <br /> m <br /> certifies the following:"I candy that iq the performLnce of the work for which this permit is issued,I shall employ persons aub;act to workman's coni <br /> lion taws of California." <br /> The applicant ITTItAt call tar e'joragyitod inspections.Comptate drawing on reverse side. 1/11/99 <br /> Title: Vi— Pr--dent Data: <br /> Signed a <br /> [} tbnVeCi� FOR DEPARTMENT USE ONLY <br /> Date Area <br /> Application Accepted by <br /> Pit or Grout inspection by <br /> Data Final Inspection bs Data <br /> Addhional Comments: <br /> 0 Stir 566.6781 ❑Ltsd 369.3621 0 Manteca 823-7100. ❑Tracy 835.6385 <br /> Applicant•R3turn all copies to: Environmawal Health PaimitlServicas 1601 E.Hazelton Ave.,P.O.Bot 2009,51k•,CA 95291 <br /> L FEE AMOVHT DUE AMDl1NT RELAITTED [ASH RECEIVED By SATE .Ft I"' . <br /> INFO -}---^ I <br /> , Ei,1324Ittsti',rr•sil <br /> Ext 1426 V <br /> f <br />