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Y APPLICATION FOR PERMIT i SAN JOAQUIN LOCAL HEALTH DISTRICT YMENi 1601 E. HAZE T ON AVE., STOCKTON, C�E G E l V E D Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISS"JP 0 0 1990 (Complete in Triplicate) i 'I�p t�I1,,t _ Application is hereby made to the San Joaquin Local Health District for a permit to construct antli��'ili Q 11MW r E&T9ed. This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump%nn12lhhffogRVaf Ffgulations of the San Joaquin Local Health Distdct- r 2 Job Address 1405 South Fresno Avenue CityStockton Lot Size 25,000 ft_ PM 63102 Owner's Name Pet Incorporated Address 400 S_ 4th St. , St. Louis' MO Phone (314) 62 —5400 2140 Eastman Avenue 1 r ContractorMCC1.elland ConsultantcAddress Ventura. CA 93003 License No.C-57 .55601-'Phone(,805)644-553 TYPE OF WELL/PUMP: NEW WELL L WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER-fir DISTANCE TO NEAREST: SEPTIC TANK: SEWER LINES 2,J-5_0__ft_ DISPOSAL FED. PROP. LINE A FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 8— inch Dia. of Well Casing .2 iftCh ❑ Domestic/Private Z Gravel Pack ❑ Tracy Type of Casing SCH 40 RYC Specifications r-1 Public (_] Other ❑ Delta Depth of Grout Seal 3 feet Type of Grout cQTtCY'ete I i Irrigation ---Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material lBelow 501 TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIR/ADDITION I I DESTRUCTION { I (No septic system permitted if public sewer is a available within 2D0 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms v1 Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments F PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line C` LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line H t ^ , I SEEPAGE PITS l 1 Depth I Size Number v SUMPS 0 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that t 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 Joaquin Local Health Dilarict. 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 call for a Rei inspections. Complete drawing on reverse side. _r - ' +�/ d Signe� 7 Title: I/l«-�r �6 Date: _/1.3 FOR DE MENT ONLY r Application Accepted by Date Area Pit or Grout Inspection by Fate 3j5 incl Inspection by Date d Additional Comments: �9i ❑ Stk 466-6781 ❑ 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 INFOFEE AMOUNT DUE AMOUNT REMITTED CASH CK RECEIVED BY DATE PERMIT'No. +.EH 13-24 iREV.t/n51 fo EH 14-28 IL