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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICTEO� �C. c� it) U 1601 E. HAZTON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED JAN 17 1990 (Complete in Triplicate) ENViRONMENTAL HEALTH PERRMIT '� n%/Jr-r, 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/purnp and the Rules and Regulations of the San Joaquin Local Health District. Job Address 1815 Navy Drive City Stockton Lot Size Industrial PM owner's Name Silgan Container Corp. Address 1815 Navy Drive, Stockton, CA phone X209 466-1031 Bakersfield,CA Contractor Melton Drilling Address 7101 Downing Ave. , License No. 508270 Phone_ (805)589-0 321 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT L.7 DESTRUCTION (J Three Groundwate PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER K monitoring wells DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES __ DISPOSAL FLD. PROP. LINE *Se? -gi to FOUNDATION * AGRICULTURE WELL OTHER WELL * PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION IFI O [X Industrial GWM64 ❑ Open Bottom ❑ Manteca Dia. of Well Exc tion of Well Casing 4" l I Domestic/Private N Gravel Pack ❑ Tracy Type of Casing pecifications I') Public I 1 Other ❑ Delta Depth of Grout Sea '— ype of Grout_CemMt I I Irrigation ___ Approx. Depth I I Eastern Surface Seal Installed by Melton Drilling -- Repair Work Done 11 Type of Pump N/A H.P. -- State Work Done _. Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material (Below 50') -- TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) 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 ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal _ Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 1 1 Depth Size _ Number SUMPS L I 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 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 11 for II require s coons. Complete drawing on reverse side. Signed X _7 Title: __P_ e id(-_T . Date: 1-12-90 J FO PAR USE ONLY y/ Application Accepted by �� Date�� ? Z�! Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Silk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO. EH 132 INFO CASH IREV.rinai 3S ov_, r 7 f' ) /2�_�// �'�/�jcp EH 14 26 /CJ