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L � sem-" APPLICATION FOR PERMIT . { SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone 42091 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is heiehy 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 12000 block W. Lammers Road City �cS' Lot Size PM Owner's Name PAC-TEL CELLULAR Address 650 Howe Ave . #300 Phone(916)646-3773 Sacramento, California Contractor EARTHTEC, LTD. Address 1830 non S 7 License No. 408595 Phone(916)786-526 TYPE OF WELL/PUMP: NEW WELL ❑ WELL P rPLA MENT 0 DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER X Test Boring DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well ExcavationZ-1-r-1—CHDia. of Well Casing 0 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing NIA Specifications a I'I Public K1 Other Test Borrbug Depth of Grout Seal Full depth_ Type of Grout PCC with I I lfricgation M IApprox. Depth l I Eastern Surface Seal Installed by men—LQ1ZL e Repair Work Done L7 Type of Pump H.P, State Work Done 0 Well Destruction ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.i 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, TREATIIIENT PLT. ❑ Method o1 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 I I Depth Size Number SUMPS 0 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 tali fo all required inspections. Complete drawing on reverse side. Signed X Title; Principal Dale: Feb. 2, 1990 FOR EPPARTMENT USE ONLY 9 Application Accepted by Dale ozr Qr L Area �Y Pit or Grout Inspection by Date Final Inspection by Datek� IFv Additional Comments: Ca Stk 466-6781 0 Lodi 369-3621 ❑ Manteca 823-7104 © Tracy 1335-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Bax 2009, Stk., CA 95201 FEEAMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT�NO. INFO c C H r D