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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 KA JOB 20-3574-01 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED- (Complete in Triplicate) S5-070-2q Application in hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in coteplianoe with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin county Public Health services. APN .#055-070-14 GRAIN STORAGE TANKS JbAddf r � �12'iWEST OF I-5 City Lot Size/Acreage forwEr� snfc-it r sc�uv Owner's Name KLEIN BROS. LTD. Address 1305 W.FREMONT ST. ,STOCKTON phone Contractor Spectrum/Kleinfelder Address 2825 E. Myrtle Street License No. 512268 phone 948-1345-- TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTIONS-0ut--azSa=Wca3t+i.�-� PUMP INSTALLATION O SYSTEM REPAfR O OTHER LX DISTANCE TO NEAREST; SEPTIC TANK SEWER LINES DISPOSAL FLD. _Test Bor'ngs FOUNDATION AGRICULTURE WELL OTHER WELL Pi*SfSktMP& 20'-40' De ap INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Dia 0 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation No GW anticipated ['I �Ov Cl Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ �0�13 If GW I'I Public Cl Other n Delta Depth of Grout Seal Type^of-Aron[ S I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by encountered,will e` Repair Work Done U Type of Pump H.P. State Work Done, backfill With Well Destruction ❑ Well Diameter Sealing Material & Depth "hole plug'' Depth Filler Material & Depth ` TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDITION ( I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.I Installation will serve: Residence___- Commercial_ Other Number of living units; Number of bedrooms Character of loll to a depth of 3 feet; Water table depth SEPTIC TANK. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. C) Method of Disposal Distance to nearest: Well foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER'BED 0 Distance to nearest: Well Foundation Property Line a 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,stale 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." Contractors hiring or subcontracting signature certifies the followin "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 Califo a ' The applicant s al o uired in ti o plate drawing on reverse side. 1 C, Project Engineer 3-19-92 Signed X Title: Date: . EPARTMENT USE ONLY 7 Application Accepted by Dat e9 Area d U60#11S40 0644,j6& Pit or Grout Inspection by Date Final Inspection by Data ,t)d Ev,DEl )A.tia.inJ� Additional Comments: tTmi; gi;� �� '*" 84 Ir 1-17 Applicant - Return all copies to: San'Joaquin County Public Health Services u+Tv E {"46 i Environmental Health Permit/Services ` 445 N San .Joaquin, P O Box 2009, Stkn, CA 95201 g 3 FEE AMOUNT DUE AMOVNT'.WEMITTED CK s RECEIVED INFO CASH BY RATE PERMIT'N0. EH 58 Ear It-24(REV 1/A s) �'L