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it APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES I ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) tApplication 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. 51+9 and 1862 and the Rules and Regulations of San !Joaquin County Public Health Services. 'Job Address 1.320 W. Weber Ave. City Stockton Lot Size/Acreage Owner's Name Union Ice CgMaLiy Address 1320 W. Weber Ave. Phone 209 948-1231 Contractor_Osterberg & Stewart _Address 2741 Road, Modesto license No. 446670 Phone (209)_537-5767 -iiTYPE OF WELL/PUMP: NEW WELL ❑ - WELL REPLACEMENT ❑ DESTRUCTION o Out of Service Weil Ll y PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ] Monitoring Well Ill. lDISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE See Map FOUNDATION AGRICULTURE WELL.. OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 8 SOIL Borings Industrial ❑ Open Bottom Q Manteca Dia. of Well-Excavation Dia. of Well Casing �kC7 Domestic/Private 111 Gravel Pack ❑ Tracy Type of Casing___ Specifications . FTI Public CI Other fl Delta Depth of Grout Seal MaX. 17 Type of Grout Neat CeIReIlt� ent; 41 I Irrigation — Approx. Depth I i Eastern Surface Sed! Installed by QaLerherg & Stewart, Inc. 114epair Work Done 0 Type of Pump H.P. State Work Done Sealing Material & Depth Well Destruction ❑ Well Diameter _ !� Depth Filler Material 5 Depth !'TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDtTION E I DESTRUCTION I l lNo septic system permitted if public sewer is available within 210 leer.i j Installation will serve: Residence_-_. Commercial,_..^ Other ! Number of living units: Number of bedrooms i� Character of soil to a depth of 3 feet: Water table depth N 'SEPTIC TANK. ❑ Type/Mfg Capacity No. V T :PKG. TREATMENT PLT. Cl Mer I� Distance to nearest: Well Foundation Property CEIV D FEB 2 4 1992 LEACHING LINE ❑ No. & Length of lines Total lengthtsize NTY ;FILTER BED ❑ Distance to nearest Well Foundation Prgp� r U!�VICES . II tt''UU ttiiLL t� .;;SEEPAGE PITS 11 Depth Size Number JESUMPS LI Distance to nearest: Well Foundation Property Line �iDISPOSAL 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 IF rules and regulations of the San Joaquin County 4 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 �ocertifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall employ persons subject to workman's compensa- tion laws of California." ,The applicant must call for all required inspections. Complete drawing on reverse side. Signed x_-.f .cutr. -�2 1� _ Title: +!�2kz �° ' Date: 2720792-_ FOR DEPARTMENT USE ONLY LOp °pq.O!7 S ! Application Accepted by Q �1 Date 3 � A Area E Pit or Grout Inspection by Date J"a Final Inspection by Date_ ii Additional Comments: -1'r8X Z» r��7a �2 Applicant - Return all copies to: San Joaquin County Public Health ServicesAW4 {7.1(•1(2, i E Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 i FEE AMOUNT DUE AMOUNT REMITTED CK I RECEIVED By DATE PERMIT'NO. INFO f� �n CASH �y►y�/�{ . EH !13-21IREv.tiNsJ S�e'�� U� �V �,■ I . Qa-.b :in EH 113.30 CCg !!!