FIELD DOCUMENTS AND WORK PLANS 1991

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• APPLICATION FOR PERMIT 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELiON 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�,. ribe This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for we pump an s a ulations the San Joaquin Local Health District. Job Address Walker Lane 1100' South of Main Street City Stockton Lot Size PM Owners Name Marley Cooling Tower Camoany Address 150 North Sinclair Avenue Phone 465-3451 Contractor Layne Environmental Address Long Beach, CA License No. 057600469 Phone 213 595 6551 TYPE OF WELL/PUMP: NEW WELL 13 WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 1501 SEWER LINES 500+ DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS KI Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 13 3/4 Dia. of Well Casing 8 5/8 ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Steel Specifications FI Public R1 Other 11 Delta Depth of Grout Seal 150 Type of Grout Neat Cement _ I I Irrigation —.Approx. Depth I I Eastern Surface Seal Installed by Layne Environmental Services Inc _ Repair Work Done ❑ Type of Pump SUBM. H.P. 1/2 State Work Done_ Well Destruction ❑ Welt Diameter Sealing Material (top 501 Depth Filler Material f8elow 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION 1 11No septic system permitted if public sewer is available within 200 feet.) ( n Installation will serve: Residence_ Commercial_ Other ,■� �1 Number of living units: _ Number of bedrooms—XM e� Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfghon ,Cegacity Method Compartments PKG. TREATMENT PLT. C1f-t t� 31 Distance to nearest: WeIL_„�ppfl{f{d11r 'NIT Property Line n F��PLTH=r1`'irB{'JN LEACHING LINE ❑ No. & Length of lines -.,�I1NMENTAT Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS 0 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 Dihtrict. 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 call for all required inspect ns. Complete drawing on�j�,iBljlyerseside. Signed X Title: 77/l�Slrl // lid��_/J Data: r' FOR P T SE ONLY 7/ Application Accepted by Date `/ Area Pit or Grout Inspection by Date Final Inspection by Date 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, Silk., CA 95201 FEE AMOUNT DUEAMOUNT REMITTED CASif H RECEIVED Y DATE PERMIT NO. G NFO . EH 13-24(REV.1/x5) 09,� ��J ' v 7 EH 1435