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Pc APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P 0 BOX 2009, STOCKTON, CA 95203. (209) 468-3447 PSRNIT EXPIRrS 1 XEAR PM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the vork herein described. This application is made in compliance vith San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 1 555 March Lane - City Stockton Lot Site/Acreage 13 .26 acres l Mass & Craig 1919 Grand Canal Phone 209 477-550 ! Owner's Name Address P.o. Box 157 C57--522125 707 j Contractor Bay Area ExSUi S n,., CA 94SRr, .__License No. C57-5221 one 4-231 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well Cl. PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER XX Monitoring Well �0 N A DISTANCE TO NEAREST: SEPTIC TANK NZA SEWER LINES rm - S?r'- _ DISPOSAL FL1O. PRO . & Boring XX X25 t FOUNDATION Lar AGRICULTURE WELL _V_A OTHER WELL N A PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS fl Industrial O Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Wall Casing N A i U Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing None Specifications * Public la Other ❑ Delta Depth of Grout Seal TD to Surf ac of GroucNeat Parti Ild CJ Irrigation Approx. D�epth ❑ Eastern Surface Seal Installed by Ba Area EX 1orat ign Repair Work Done U Type of Pump NPA H,p. N/A tate Work Don Well Destruction ❑ Well Diameter 4 it sealing Material i Depth Grout to Depth A22rox. 601 Filler Material i Depth None TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPAIR/ADDITION Ll DESTRUCTION G iNo septic system permitted it public sewer is available within 200 feet.) i Installation will serve: Residence— Commercial_ Other i 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.0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/sire 25 FILTER BED G Distance to nearest: Well Foundation Property Line t SEEPAGE PITS I I Depth Size Number SUMPS Ll 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;we, and rules and regulations of the San Joaquin County 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 hiririg or subcontracting 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 workmen's compensa- tion laws of Calif rnia." The applicant rt s call for ail uir ins cions. Complete drawing on reverse side. ' Signed c� Titre: President pate; October 10 , 1990 tephen . C1a for Bay Area X lorati A T ENT USE ONLY Application Accepted byDats �7v 3 Pit or Grout Inspection by Data Final Inspection b Dated Additional Comments Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES q ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 85201 INFO FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED 8Y DATE PERMIT'NO. I K 120 EY.I/F151 , � /0 t7 fa 0 2773