FIELD DOCUMENTS AND WORK PLANS 1988

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APPLL,CATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone_(209) 466-6781 PERMIT EXPIRES 1-YEAR FROM DATE ISSUED lComplete in Triplicate) ,{TApplication is,hereby made to the San lJoat in Local Health District for a permit to construct and/or install the work herein described.This application is made in cors chance with San Joaquin County Ordinance No 549 for sewage or No 1962 for well/pump and the Rules and Regulations of the Sen Joaquin , �.� t He�iml�ala. Job Address 150 N Sinclair 'Avry, enue - , `Gtockton Lot Size - . 'PM Marley Cooling Owner's Name TOWer Company Address 15 0 N Sinclair a; r Stk, CA Phone — 345 r 16018 valley Blvd. (714) ContractorLayne EnvfronmentaAddressF'nntana, CA 92335 License No.4525_Q9_MPhone — 3355 TOE OF WELL/.PyMP: C, NEW WELL ❑ WELL REPLACEOENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER MSOIL BORING (25) DISTANCE TO NEAREST: SEPTIC TANK 525 SEWER LINER}: 5. r�} ,,6ZSRf.JSAL FLD. PROP.A �.i � 198II FOUNDATION AGRICULTURE WE`LL'��' U OTHER WELL PITS/SU PS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS " ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of WallCasing, ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications M Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout_ 1 1 Irrigation _.Approx. Depth I I Eastern Surface Seal Installed.by _ Repair Work Done ❑ Type of Pump r H.P. _ State Work Done_ Well Destruction ❑ ,Well Diame r " /Spling Material Itop 50'1 r y q�, Depth r �7 14iller Material (Below 50'1 sox^' TYPE OF SEPTIC WORK: NEW INSTALLATION I REPAIR/ADDITION 1 I DESTRUCTION I I (Norgaplic system permi to ubi'c ^'�l available within 200 feet.) /w�� Installation will serve: Residence_ Commercial__ Other.--- Number ther.__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 I Depth _Size_._-- Number SUMPS H 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: "1 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."Cont"ctor's hiring or sub-contracting signature certifies the following:"I certify that in the performance of the work for which this permit is iswensa- ed,I shall emplgy persons subject to workman's comp tion laws of California." i.� The applicant must call for all required in actions. mp a drawing on reverse side. ll/ Signed X_ `C -_a Tide: Hydrogeologist Date: April 6 , 1988 FOR DEPARTMENT USE ONLY Application Accepted by — - - Date y f r l fr F At" Pit or Grout Inspection by Date Final Inspection by. Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 623-7104 ❑ Tracy 835.8385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O.Box 2009, Stk., CA 85201 PERMIT'NO. AMOUNT DUE AMOUNT REMITTED y DATE FEE CASH INFO RECEIVED B . EH 13-24 IN EV.11 e5) EN 14215 ✓