FIELD DOCUMENTS AND WORK PLANS 1991

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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRILR 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 uplication PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 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 Sinclair Avenue, 800' South of Washington Street City Stockton Lot Size PM owner's Name Marley Cooling Tower Company Address 150 North Sinclair Avenue Phone 465-3 51 Layng Environmental Contractor 5 rvlces. nc. Address Long Beach. CA License No.C57600469Phone TYPE OF WELL/PUMP: NEW WELL IN WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES 18' DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 61 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 13 j/6 Dia. of Well Casing ❑ Domestic/Private Cl Gravel Pack ❑ Tracy Type of Casing Steel Specifications fl Public (k Other Ll Delta Depth of Grout Seal 100 Type of Grout Neat Gement__ I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Lyne Environmental Servirpc, Tnr _ Repair Work Done ❑ Type of Pump SOBM, H.P. 1/2 State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.l Installation will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms '{ Character of soil to a depth of 3 feet: w�/�EN■ Water table depth SEPTIC TANK ❑ Type/MfgCapacity No. Compartments PKG. TREATMENT PLT. ❑ .1 Method of Disposal Distance to nearest: ell?. 3 1-Folun Ion Property Line �rlcrs LEACHING LINE ❑ No. & Length of lines SPIN $t1J N Total length/size FILTER BED ❑ Distance to neares ENvNA€NTpLH oundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 D3trict. 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.-Contractors 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 a7X :�� t call for all required inspections. Complete drawing on reverse side. J�J��t /� SigneTitle:P� 1.4�� 3"42 1fY 4 Data: ir wT r rTP� c / w, v OR RTMENT USE ONLY Application Accepted by Dat rea Pit or Grout Inspection by Date'- Final Inspection I Dates Z �/ Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ 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 CK 4 FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. INFO r ) . EH 13.111REV.11x11 g-//J'O`er - 5j I-/Cob EH 11 r. ..