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APPLICATION•FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL i ON AVE., 5TOCKTON, CA Telephone {209} 466-6781 SAN X990 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) ENVIRONMENTAL HEALTH, P f NIfT I gr-D1(�rlcc Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the wor erein desc" ed. 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 1815 Na Drive city Stockton Lot size Industrial PM Owner's Name Silgan Container Address Cor 1815 Navy Drive, Stockton CA Phone _ (209)466-1031 i r Bakersfield,CA Contractor Melton Drillin Address 7101 Downing Ave. , License No. 508270 Phone (805)589-052l i TYPE OF WELL/PUMP: NEW WELL q WELL REPLACEMENT ❑ DESTRUCTION D Three Groundwate PUMP INSTALLATION ❑ SYSTEM REPAIR Cl OTHER 793 monitoring wells I DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION * AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS X Industrial GTAW ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 12" Dia. of Well Casing 4" 1 ❑ Domestic/Private (K Gravel Pack ! ❑ Tracy Type of Casing Specifications FI Public Cl Other 1 Cl Delta Depth of Grout Sea! 4'—5' Type of Grout f+ment. _. I I Irrigation —.Approx. Depth i I Eastern Surface Seal Installed by Melton Drilling Repair Work Done ❑ Type of Pump I N/A H.P. -- State Work Done Well Destruction ❑ Well Diameterl Sealing Material (top 501 j Depth I Filler Material (Below 501 -- i TYPE OF SEPTIC WORK: NEW INSTALLATION I] REPAIR/ADDITION I I DESTRUCTION I i (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_'i Commercial— Other C, Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: ,I Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance td nearest: Well Foundation Property Line I � � LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS l I Depth Size Number SUMPS Cl 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 laws, and rules and regulations of the San JoaquimLocal 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 II for II require s ctions. Complete drawing on reverse side. Signed Title: PreS jablit Date: 7.=12=90 FO PAR USE ONLY y//� Application Accepted by Date `2 ? ! `� a C Pit or Grout Inspection b Date ' � Final Inspection by Date�r Additional Comments: ❑ Silk 466-6781 C] 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. 1 INFO CASH 1 EHM24IREV.I/N5) 3s /*