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APPLICATION Onk/ �3 r SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES I 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 with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address STADIUM DRIVE & SANGUINETTI LANE City ., STOCKTON Lot Size/Acreage Owner's Name Address Phone PC EXPLORATIONr INC. address 1780 VERNON ST. ROSEVILLLE License No. 265556 phone 916-783-973 Contractor TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n..'s - DESTRUCTION I Out of Service Well ❑. PUMP INSTALLATION O SYSTEM REPAIR t7` OTHER O Monitoring Well 0 DISTANCE TO NEAREST: SEPTIC TANK" - "' SEWER TINES*` - `.._-,�,.- DISPOSAL FLD.-- -- —PROP.-LINE - - FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 171 industrial ❑ Open Bottom - ❑ Manteca Dia. of Well Excavation Dia. of Well Casing Cl Domestic/Private Ll Gravel Pack*' y. G] Tracy Type of Casing_ Specifications FI Public CI Other n Delta Depth of Grout Seal Type of Grout 1 1 Iffigation Approx. Depth t 17.Eastern Surface Seal Installed by Repair Work Done L3 Type of Pump H-.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material b Depth Depth Filler Material A Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I 1 Mo 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 0 Distance to nearest: Well . Foundation Property Line EWT' SEEPAGE PITS 11 Depth Size J Number 1J993 SUMPS Cl Distance to nearest: Well Foundation _ Property Line DISPOSAL PONDS ❑ !IOAQUj(V COUNTY I hereby certify that I have prepared this application and that the work will be done in accordance with San JogWAVNMK and rules and regulations of the San Joaquin County H DIVISION 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 persona subject to workman's compensa- tion laws of califo The applicant u all for all uir coons. Complete drawing on reverse side. Signed Title: GENERAL [MANAGER Date: 8/23/93 FOR DEPARTMENT USE ONLY �r Application Accepted by __ __ Date AreaAd fA11fZo.�` ' Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services n Environmental Health Permit/Services L^ �Og 445 N San Joaquin, P O Box 2009, Stkn, CA 95201FEE v �� INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE' PERMIT'NO. . EH 13.24 rREV.IIN5) WD 9 fH 14.26