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LIVIl.U11 11U. 7.77 V.7.0cJ s APPLICATION FOR PERMIT ON JOAQUIN LOCAL HEALTH DIST*T 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES TYEAR FROM DATE ISSUED (Complete in Triplicate) 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/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address Corral 'Hallow Sanitary Landfill city TracyLot Size PM Owner's Name -Count of__San-_Jaaquin� Address P-0- im. Strfl� Phone 12091-46 —.311fiL Consultant: EM�ON Associates 1921 Ringwoo ve. Jan ,Josge, A. 95131 (408-127-5--1-44 cD ti leor r:water Development Address 220 North East St.Wood�anense No. C57-283326Phone 916 662-28 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER [X DISTANCE TO NEAREST: SEPTIC TANK .-NA SEWER LINES NA DISPOSAL FLO. NA -- PROP. LINE 25'-300' FOUNDATION -NA.-- AGRICULTURE WELL -B— OTHER WELL 251 PITS/SUMPS NA INTENDED USE _TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS r . ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation '�! Dia. of Well Casing u o ❑ Domestic/Private (X Gravel Pack N Tracy Type of Casing PVC Specifications I'1 Public Cl Other n Delta Depth of Grout Seal 250'-300' Type of Grout Vol cl ay, 1 1 Irrigation —.Approx. Depth I I Eastern Surface Seal Installed by Cement/Bentonite _ Repair Work Done U Type of Pump H.P. , State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 501 OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No sep=depth sewer 'semavailablInstallation wil Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 tee . SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well alien Property Line LEACHING LINE ❑ No. & Length of lines length/size FILTER BED ❑ Distance t rest: Well Foundation Pro Line SEEPAGE PITS 'IDepth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line OSAL 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: "1 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 call fo required inspections. Complete drawing on reverse side. Signed r 1W for EMCON Associates Title: NA Date: 4/4/88 FOR DEPARTMENT USE ONLY Application Acceptod by Date 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, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. INFO CASH e EH 13-24(REV.1/x5) EH 14.28