FIELD DOCUMENTS AND WORK PLANS 1988

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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (2091 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 1.5-0--N..__Sinc I a i r_ - St.k-,-CA Phone _(7(19) 4(,S--4 A5j1 16018 Valley Blvd. (714) Contractor424YRe EnVirOnmentaAddressFQTltdna CA _92335_ License No.45.2.6_19L5_7Phone TYPE OF WELL/PUMP: NEW WELL n WELL REPLACEMENT 1-1 DESTRUCTION CI PUMP INSTALLATION [] SYSTEM REPAIR l l OTHER 04 SOIL BORING (25), DISTANCE TO NEAREST: SEPTIC TANK .500'_ SEWER LINES. _50 r DISPOSAL FLD. PROP. LINE ]._O FOUNDATION 25 ' AGRICULTURE WELL 2000 'OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS I Industrial 1-1 Open Bottom I I Manteca Dia. of Well Excavation Dia. of Well Casing _ Domestic/Private 1_I Gravel Pack I I Tracy Type of Casing Specifications I Public I-1 Other I 1 Delta Depth of Grout Seal __ Type of Grout Irrigation __ Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction Ll Well Diameter Nl tTer 6 5 811�1 Spling Material (top 50'1 Neat Cement (5% bentonite) Depth R F� 50 17 16iller Material (Below 501 _ J TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 INo septic system permitted it public sewer is . available within 200 feet.) Installation will serve: Residence_ Commercial _ Other______ Number of living units: Number of bedrooms (� (\\y\ Character of soiltoa depth of 3 fleet Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. LI Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Ll No. & Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth ___ Size Number SUMPS I I Distance to nearest: Well __ Foundation Propeny Line DISPOSAL PONDS I I I hereby certify that I have preparedthis 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 applicant must c II for all require inspecti ns Complete drawing on reverse side. Signed X - Title: _Hydrogeologist Date: April 6 , 1988 FOR DEPARTMENT USE ONLY 11) Application Accepted b V I t I A I�F PP P Y Date Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: 0 Sik 466-6781 0 Lodi 369-3621 0 Manteca 623-7104 0 Tracy 635-6365 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. . EH 1324(REV.ti x 5)