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f I APPLICAT10NrFOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL i ON AVE., STOCKTON, CA Y ►ri I�.�.., Telephone (209) 466-6781 g C E I V ED PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) AUG : 1990 Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. Thi plication is ` made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for weupump and tho' 'bh� P Joaquin Local Health District. nAAIITlr•r'�lrrrc' Job Address Unocal SIS #5421 7303 Pacific Ave City Stockton Lot Size PM Owner's Name Unocal Corporation Address 2000 Crow Canyon, San Ramon CA Phone 415/277-2303 1�t ��tt ho Cordova CA 94583 ContractorWest Hazmat Address 3 1 Fitzgeral$ St. License No5544979 Phone 9161638-7276 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT 0 DESTRUCTION ❑*MW1,MW!,XW3.,MW4 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑**SP ee attached t tan DISTANCE TO NEAREST: SEPTIC TANK 7.100' SEWER LINES * DISPOSAL FLD. 1001 PROP. LIN ` FOUNDATION 20' AGRICULTURE WELL :� 1001 OTHER WELL y`* PITS/SUMPs>l00 r ` INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATION 921 211 ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing SCH 40 PVC Specifications 0.02!1 Slot M Public Ill Other(MonitoriRg6elta Depth of Grout Seal Approx. 50' Type of Grout Concrete I I Irrigation 74 Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filter Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I I FIE.PAIR/ADDITION I I DESTRUCTION I I tNo septic systern 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 ' I LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS 0 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 D3trict. 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." t The applica r mu call all re d inspections. Complete drawing on reverse side. Signed `� Title; Sr Geolo ist Date:'--81 7/9 0 _ Jeffrey i K Tian Engineering, Inca P.O. Box 996, -Benicia, CA 94510 707/746-6915 FO DEPART,4IENT USE ONLY D Application Accepte by Date 6 Area { Pit or Grout Inspection by '` Date [Z t' Final Inspection by Date f Z- Q Additional Comments: ❑ Stk 466.6781 0 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, Sik., CA 95201 FEE INFO AMOUNT DU! AMOUNT REMITTED C RECEIVED BY DATE PERMIT•NO. }} �.EH 13.26]REV. /x 5) i ls/:3C'X D EH 11-26