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.� APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES HEALTH DIVISIONANf E7) Soil Borings ENVIRONMENTAL .� 445 N SAN JOAQUIN, PHONE (2CA 45201 0 Maximum Dept 11 ft i P O BOX 2009, STOCKTCol , CA 95201 U 'IN PERM T EXPIRES YE FR DTE I II IQ (Complete in Triplicate) �yB1�•MACP� � , emit to construct and/or install the work herein described. This rn4Th1 A licttion+ is Hereby,made'to San Jga=tuin County fora county PP use +• applicad�o>� Sa made inRe�hlBerviceah San Joaquin County'Ordinance No. 51+9 and 1862 and the Rules and Regulations o i Joaquin county Public !� Lot Size/Acreage � L4X- ArQS City Stockton Job Address 888 S. Figueroa St _ j Phane ni Owner's Name Santa Fe Pacific `P1 line Address ; - 2825 E. Myrtle St. Phone "" R''�; ;1 License No.�?L.8---- 4t�P['trllIil EXplOratzOn Address out of service Well C1., Contractor :--- WELL REPLACEMENT C3 DESTRUCTION ❑ E- NEW WELL ❑ OTHER ''MOnitortng Weilz 13 TYPE OF WELLIPUMP. _ - SYSTEM REPAIR ❑ �-=` PUMP'INSTALLATION� NIA POSAL FLD. N A PROP. LINE _U4&_ v a.(7) Soil Bora- S SEWER LINES _--_-- DISp1T5/SUMPS NLA DISTANCE TO NEA EST: SEPTIC TANK N/A AGRICULTURE WELL .1ILB— OTHER WELL 114A— FOUNDATION � INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Dia. of Well Casing ❑ Manteca Dia. of Well Excavation Bottom S cifications.- L3 Industrial ❑ Own B ❑ Tracy Type Type of Casing Typo of Grout — n Domaslic/private 'Ll Gravel Pack Depth of Grout Seal n other n Dena I'1 Public Surface 5en1 installed by I I Irr,Maiton -- Approx. Depth I I Eastern State Work Done of Pump!L� H.P. Repair Work Done v Type Sealing Material i Depth joho'Destruction ❑ Well Diameter` Filler Material 4 Depth Depth permitted if PULP-- wawa( is available within 200 feet.) STYPE Of.SEPTIC WORK: NEW INSTALLATION f 1` REPAIRIADDITION 4 I DESTRUCTION I I IND septic system Installation will serve: Residence Cornmerciei Other�-- Number of living units: Number of bedrooms Water table depth I Character of sok to s depth of 3 feet:", Capacity__� No. Compartments it SEPTIC TANK. O Type/9119} Method of Disposal k PKG. TREATMENT PLT.❑ Foundation �-- Property Lina'�—� < Distance to nearest: Well _� { , Totallengthlsize I LEACHING LINE C1 No. & Length of lines Property Line--�—� FILTER BED ❑ Distance'to nearest: Well-�—�— Foundation _ -- :==--'--� UmJBrti SEEoAGE-PIT - ncpt T- -:.--- - - �---- - Foundation SUMPS Ll Distanceto nearest: wall �� Property Line [Ithereby certify that 1 have prepared this application and that the work will.be done in accordance with San Joaquin county ordinances, stats larva, and DISPOSAL PONDS not rules and regulations of the San Joaquin countyie g: , Home owner or licensed agents signature certifies the following:wnrkman'artwmpensat on taws of California."'the Performance of Contractoes hiring Or su contracwork for which this permit is t ng signature Home employ any person in such manner as tri become subject , persons subject to workman's compenss- certiliei tM foftowi mify that' ttw perlormame of the work for which this permit is issued,I shall tion laws 01 Calif ie •:) The applicant uired inspections. Complete drawing on reverse side. ]l/16/92 I Title: Projectplpglst Date: Signed I FOR DEPARTMENT USE ONLY Date ! 1 Area Application Accepted by Data { Pit or Grout Inspection by ate a Final Inspet tion.by ' •� 1`� X13 � to' Additional Comments: uintjrPublic Health Applicant - Return all copies to: $an Joaquin o Environmental Health Permit/Serviceev ces 4 445 N San Joaquin, P O Boit 2009, Stka, CA 95201 1< CCK ASH RECEIVED 9YHTE PERMIY NO. FEE ,AMOUNT DUE AMOUNT REMITTED r S �y,,� �f�INFO �67 , . EM 13-74IRM+ins) EM 14.78 -