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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (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. Job Address 150 N. Sinclair Avenue city Stockton Lot Size PM Marley Cooling Owner's Name Tower Company Address 150 N_ Sinclair Stat , CA Phone (209) 465-345l 16018 Valley Blvd. (714) Contractor) nyironmentaP]ddressFontana,_ CA 92335 License Na.452609C7 Phone TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ a. PUMP INSTALLATION ❑ SYSTEM REPAIR D OTHER IN SOIL BORING42.5)" DISTANCE TO NEAREST: SEPTIC TANK 500 ' SEWER LINEgf -50_' —_, 015PSOSAL FLD. PROP. LjJ ,Er.44_!_5 , 198$ FOUNDATION Z 5 AGRICULTURE WELLv 2 Ob O OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL `PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial D Open Bottom M Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private D Gravel Pack D Tracy Type of Casing Specifications M Public Cl Other Ll Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx. Depth I Eastern Surface Seal Installed by _ Repair Work Done D Type of Pump H.P. State Work Done Well Destruction , D Well Diameter 6 9 8rr Staling Material (top 50') Neat Cement (5% bentonite) Depth S A? 50 r L7 @16iller Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION I] REPAIR/ADDITION I 1 DESTRUCTION i I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I 1 Depth Size Number SUMPS L-i 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 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 app=must all requir inspecti ns Complete drawing on reverse side. SignedTitle: H dro Bolo ist Date: April 6, 1988 FOR DEPARTMENT USE ONLY r f Application Accepted b L(I f I pp p y Date Area Pit or Grout Inspection by Date Final Inspection by 5.' ,>N/ Date ^CS� Additional Comments: ❑ Stk 466-6781 C7 Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. pox 2009, Sik., CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERM INFO + EH 13-241REV.r/H51 EH 14-2e