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80-5154-93 APPLICATION FOR PERMIT ' SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P O BOX 2009, STOCKTON, CA 95201 (209) 468-3447 PERMIT EMIRES 1 YEAR FROM DATE ISSUBD (Complete in Triplicate) Application 1s hereby made.to San Joaquin County for a permit to construct and/or initall the vork herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 121 S. CENTER STREET City STOCKTON Lot Size/Acreage 1 . 5 ACRE GREYHOUND LINES , INC. 901 MAIN STR, STE 2425 214/744-6511 Owner's Name Address Phone Contractor SPECTRUM EXP, M(Address 2825 F MYRTLE STR. License No. _51 2?68 Phone 2 0 9.14 6 9— 2, TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT O DESTRUCTION 0 Out of Service Well 0 PUMP INSTALLATION O SYSTEM REPAIR 0 OTHER O Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES 50 ' DISPOSAL FLO. NA PROP. LINE 20 r FOUNDATION 661 AGRICULTURE WELL NA OTHER WELL NA PITS/SUMPS NA INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 3-4 411 SOIL BORINGS T fl Industrial O Open Bottom O Manteca Dia. of'AM Excavation Dia. of Well Casing 4 01 U Domestic/Private 0 Gravel Pack 0 Tracy Type of Casing NA Specifications NA M Public I:1 Other O Delta Depth of Grout Seal 45 r TO SURF ACHype of Grou('aEMENT/BENT)N7 G Irrigation ._.. Approx. Depth O Eastern Surface Seal Installed by SPECTRUM EXP, INC, Repair Work Done U Type of Pump NA H.P. NA State Work Done_ Depth & Dep Well Destruction O Well Diameter Sealing Materia1� Depth Tiller Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIR/ADDITION 0 DESTRUCTION 0 INo septic system permitted if public sewer is N�l available within 200 fest.1 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 O Type/Mfg Capacity No. Compartments PKG, TREATMENT PLT. Cl Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. III Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Sire Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, stale laws, and rules and regulations of the San Joaquin County 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 tornis." The ap cant M call for all requir pgctions, Complete drawing on reverse side. Signed Title: MANAGER.— Date: 1-4-93 FOR DEPARTMENT USE ONLY / 9 Application Accepted by Date !' �`� Area Pit or Grout Inspection by Date L 2Z Final Inspection by Additional Comments: _ Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES /1 Q ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 1� V 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVEO BY DATE PERMIT NO. EM 13-24(ME EM 11•2e './ IIIYYY