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APPLICATION FOR PERMIT P PAYMENT RECEIVED SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA SEP 2 8 1987 Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIRONMENTAL HEALTH (Complete in Triplicate) PERMITISERVICES Application is hereby made to the San Joaquin Local Health District 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 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 3505 Navy Drive Stockton, CA City Lot Size PM Owner's Name Mobil Oil Corpora tiOIAddress P.O. Box 127 Richmon CAPhorie415-849-706 ContractorExploration Geoserydds ceSan Jose ress 1175 Co01 i ae Ave License No. 484288 Phon — _ 2 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER kk boring DISTANCE TO NEAREST: SEPTIC TANK1� 00 r SEWER LINES 1< 50 ' DISPOSAL FLD. r PROP. LINE>SO ' FOUNDATIONS 50 AGRICULTURE WELL > 100 'OTHER WELL >'100 ' PITS/SUMPS 7100 ' (�1 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS l I1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavationti N�_ _ Dia. of Well Casing � XW Domestic/Private Cl Gravel Pack 1:1 Tracy Type of Casing- NA Specifications I'I Public kIKOther Ixl Delta Depth of Grout Seal NA -- - -- Type of Grout Irrigation Approx. Depth I I Eastern Surface Seal Installed by NA Repair Work Done I 1 Type of Puneat r-PmPn mp H.P. ______ State Work Done _ Weli Destruction 1 ! Well Diameter _ Sealing Material (top 50'1 neat- C` mPnt pnt i ro hnring Depth Filler Material (Below 50'1 � TYPE OF SEPTIC WORK: NEW INSTAL-CATION I I REPAIR/ADDITION I DESTRUCTION I I available within 200 INo septic system permifeet.)tted if public sewer is Installation will serve: Residence Commercial Other � Number of living units: Number of bedrooms \\ Character of soil to a depth of 3 feet: ------ ---- _ Water table depth SEPTIC TANK f l Type/Mfg PKG. TREATMENT PLT. l Capacity-,-- --- -- _ No. Compartments f Method of Disposal Distance to nearest: Well -_ Foundation Property Line LEACHING LINE ❑ No. & Length of lines 5 Total length/size FILTER BED [ I Distance to nearest: Well _ Foundation Property Line1 grrtQ -- - - - - -- - - - - - �Q= - SEEPAGE PITS I I Depth _ Size _ - - - - - - — — Number --f q, SUMPS 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 cou y anc stat laws, ani° rules and regulations of the San Joaquin Local Health District. 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 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 California." The applicant must call for all required inspections. Complete drawing on reverse side. Signed X 111,111ill,11111111I Title: nPnl nni q i- — --- Date: 9-24-27 Kaprealian Engi ering IWR DEPARTMENT USE ONLY P.O. Box 3 Benicia A 94510 �i Application Accepted by Date g l6--g 7 ,/Area "(�f Pit or Grout Inspection by l/t/ Date G'2 ZiFinal Ins -Inspection by l.�.zs. — Date �� Additional Comments: O�lr1� /� ��f �� Jley ' ElStk 466-6781 ElLodi 369-3621 O Manteca 823-7104 O Tracy 835-6385 /b µ A_ppppJican Return all opie to: n ronmental Health Per itJServices 1601 E. Haz ton Ave, P,0- Box , Stk., CA 1 7 `'� .4. Oj Zivs� p•✓a,u a�fI-,+sc �j h., FEE AMOUNT DUE AMOUNT REMITTED INFO CASH RECEIVED 8Y DATE PERMIT'NO. . EH 13-24(REV.i n 51 ^� EH 14-28