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APPLICATION *404, SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN,PHONE(209)469-3420 P O BOX 388,STOCKTON,CA 95201-0388 PERMIT EXPIRES 1 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 Development Title Section 9-1110.3 and Section 9.1115.3 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 145 SOUTH SUTTER STREET City STOCKTON Lot Size/Acreage 1 SAN JOAQUIN COUNTY Owner's Name CAPITOL PROJECTS Address 222 E. WEBER AVE, RM 678 _ Phone 209-476-1635 Contractor SPECTRUM Address 2825 E. MYRTLE ST. License No. 51-2268 Phone 209-465-8712 TYPE OF WELL/PUMP: NEW WELL ❑ (2) WELL REPLACEMENT W (2)DESTRUCTION XI Out of Service Well N PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK > 50 FT SEWER LINES > 50 DISPOSAL FLO. > 50 PROP. LINE X50 FOUNDATION 50 FTAGRICULTURE WELL 750 OTHER WELL 7 50 PITS/SUMPSIt5O INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom Cl Manteca Dia. of Well Excavation Dia. of Well Casing 4—INCH ❑ Domestic/Private M Gravel Pack ❑ Tracy Type of Casing_ PVC Specifications I') Public 1-1 Other 11 Delta Depth of Grout Seal 40-45 FT Type of Grout BENT/CEMENT I I Irrigation 70 FTApprox. Depth I I Eastern Surface Seal Installed by DRILLER Repair Work Done U Type of Pump NONE H.P. State Workiqons INSTALL 2 WELLS• DESTRO Well Destruction ❑ Well Diameter 4—INCH Sealing Material A Depth BENTONITE/CE WELL Depth APPROX. 70 FT Filler Material i Depth #IC SAND FROM APPROX. 48 TO 70 FT. 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 sed 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 Lim LEACHING LINE ❑ No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Founaahon Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Lim DISPOSAL PONDS O I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, slate lawn, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the peiformance of the work for which this permit is issued, I shall nol 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 shelf employ persons subject to workmen's compa es- tion laws of California." The applicant t call f I r u d insspectic,S. CC�molars drawing on reverse side. Signed x IM=Tide: REGISTERED GEOLOGIST Date: �l FOR DEPARTMENT USE ONLY Application Accepted by - Date Area Pit or Grout Inspection by ■uv Dais Final Inspection by Date MW A Additional Comments: \MALA 1",VV Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N.San Joaquin,P.O.Box 388,Stockton,CA 95 201-03 88 v INFO FEE AMOUNT DUE AMOUNT REMITTED /CASH RECEIVED BY 1DATE qL PERMIT NO. O1, . EN i 4-M IAEv. ,�.si 7 L. 221 S b T'bi-{ ✓ da�° cr'•Yp =a fN td.]a