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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE i ON AVE., STOCKTON, CA Telephone 1209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED r I ., (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. 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. i Job Address 1405 South .Fresno Avenue City Stockton Lot Size 25,000 ft2 PM 400 South Fourth Street Owner's Name Pet Incorporated Address St Louis, MO 63102 Phone (314)621-5400 # 2140 Eastman Avenue C-57 Contractor McClelland Consultazu cess Ventura CA 93003 License No. 556015 phork805)644=5535 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTIONX PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ j DISTANCE TO NEAREST: SEPTIC TANK t SEWER LINES DISPOSAL FLD. _ PROP. LINE FOUNDATION:— AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private XdblGravel Pack ❑ Tracy Type of Casing Specifications FI Public Cl Other F1 Delta Depth of Grout Seal Type of Grout vJt/I S='4 I I Irrigation Approx. Depth l I Eastern Surface,Seal Installed by �! Repair Work Done ❑ Type of Pump H.P. State Work Hone I Well Destruction 3tkX Well Diameter - 2tt_4tr Sealing Material itop 50'1 V Depth 25-35 ft Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION l 1 REPAIRIADDITION l I DESTRUCTION l I (No septic system permitted if public sewer, is ' available within 200 feet.► 1 rt Installation will serve: Residence_ Commercial_ Other �J 15 Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth I" SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ t Method of Disposal Distance to nearest: Well Foundation Property Line V LEACHING LINE ❑ No. & Length of lines Total length/size ; FILTER BED ❑ Distance to nearest: Well Foundation Property Line a ;' SEEPAGE PITS I I Depth Size _ Number SUMPS ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 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 Joaquin Local 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 applican must call for I requir d ins tions. Complete drawing on reverse side. �y p' Signed X Title: re4i Date: EP NT USE ONLY J, �a Application Accepted by l Date ea Pit or Grout Inspection by Date Final Inspection by Date li Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-36211 ❑ 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 INFO AMOUNT DUE AMOUNT REMITTED CK H RECEIVED BY DATE L PERMIT NO. { //T I +.EH1 -241REV.tiH51 EH 14-26 e