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T oo OD 1S5 cic <br />AMOUNT DUE AMOUNT REMirrE0 RECEIVED BY DATE PERMIT NO. CASH <br />Page 13A <br />APPLICATIOIN <br />SAN JOAQUIN COUNTY PUBLIC HRALTH SEE ICESF <br />. ENVIRONMENTAL HEALTH DIVISION .1.g11/4 <br />445 N SAN JOAQUIN, PHONE (209)468-3420 <br />P 0 BOX 2009, STOCKTON, CA 95201 <br />PERMIT F.IYPIT77 "'EAR FROM DATE ISSUED <br />(Complete in Triplicate) ENVIRONMENTAL HEALTH <br />PERMIT/SERVICFS Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein descrfbed. This application is made in compliance vith San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin Ccunty Public nealtn Services. <br />920 N. Shaw Road Job Address City Stockton Lot Size/Acreage 2.5 AC <br />Fresh Start Foods Inc. 920 N. Shaw Road, Stockton P on 209-462-3610 Owner's Name Address p <br />w,e.--- Sac cff q5 <br />466270 <br />1 <br />Contractor Taber Consultants Address 536 Galveston Street License No, Phone 916-371-1690 <br />TYPE OF WELL/PUMP: NEW WELL C WELL REPLACEMENT El DESTRUCTION El Out of Service Well Cl <br />PUMP INSTALLATION Cl SYSTEM REPAIR C OTHER21 Monitoring Well <br />soil borings C <br />. DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD PROP LINE <br />FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br />INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br />CI Industrial Cl Open Bottom Cl Manteca Dia. of Well Excavation 6 .3/4 Inch Dia. of %km!! Casino <br />1') Domestic/Private C Gravel Pack Li Tracy Type of Casing Specifications <br />Type of Grout cement .c,.1,12:2.ze VC i'l Public [1 Other fl Delta Depth of Grout Seal <br />1 1 Irrigation Approx. Deptncastern Surface Seal Installed by <br />Repair Work Done L.:3 Type of Pump H.P. State Work Done <br />Well Destruction Cl Well Diameter <br />Depth <br />Sealing Material & Depth <br />Filler Material is Depth <br /> <br />TYPE OF EPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION t I DESTRUCTION I I (No septic system permitted if public sewer is ‘.-0 <br />available within 200 feet.) <br />Installation wil e Residence Commercial Other <br />Number of living units: Number of bedrooms <br />---) Character of soil to a depth o feet • Water table depth <br />SEPTIC TANK 0 Type/ M Capacity No. Comoanments <br />Method ot Disposal <br />C..) Distance to nearest:ell oundation Propenv Line <br />LEACHING LINE El No. & Length of Total length/size <br />FILTER BED El Cistanc nearest: Well Fo ation Property Line <br />SEEPAGE PITS I Depth Size <br />SUMPS Li Distance to nearest: Well Foundation Property Line <br />DISPOSAL ONDS 0 <br />I hereby certify that I have prepared this application and that the work will be done in accoraance with San auin county ordinances, slate laws, and <br />rules and regulations of the San Joaquin County <br />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 <br />employ any person in such manner as to become subject to 4,,,,,,,,,,,ciii ., _Jmpensation laws of California.- Contractor's hiring or sub-contracting signature <br />certifies the following: "I comfy that in the performance of the work for which this permit is issued, I shall employ persons subject to workmen's compensa- <br />tion laws of California." <br />The applicant must call or all r ed inspections o me dr wing on reverse side. 7z4 <br />6 , <br />specUon by <br /> <br />Applicant - Return all copies to: San Joaquin County Public Health Services <br />invircnTontal Health Permit/Services <br />445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 <br /> <br />c4L. J u l 2 7 1994 <br />PKG. TREATMENT PLT. Cl <br />SiglWdK <br />Application Accepted by <br />Pit or Grout Inspection by <br />Additional Comments: <br />q <br /><OR EPA TMENT USE ONLY <br />Title: Senior Geologist <br />Date: <br /> 7/26/94 <br />ate Area - <br />ci35' <br />Date <br />i FEE <br />INFO <br />EH 13.24 5JI <br />EH 14.2a