FIELD DOCUMENTS AND WORK PLANS 1991

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• APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON 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 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 465-3451 Contractor S�errvvices�iinc. nil Address_Lon Beach. CA _ 9 License No.C57600469 Phone TYPE OF WELL/PUMP: NEW WELL A WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES is, DISPOSAL FLO. PROP FOUNDATION AGRICULTURE WELL OTHER WELL U INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATION Q Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation . of all Casing 13 Domestic/Private ❑ Gravel Pack ElTracy Type of Casing Steel Specifications M Public 56 Other n Delta Depth of Grout Seal 100 Type of Grout Neatee0t___. I I Irrigation _.Approx. Depth I I Eastern Surface Seal Installed by Layne EnyironnientaT Servirec Tne _ Repair Work Done ❑ Type of Pump SUBM- H.P._1/9 State Work Done _ r Well Destruction ❑ Well Diameter Sealing Material (top 50') Depth Filler Material (Below 50') _ TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION f I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms .p Character of soil to a depth of 3 feet: �N ` Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ T� 4 �]+1 Method of Disposal Distance to nearest: Moil r)2 3 t94union Property Line H (U)u44 1 LEACHING LINE ❑ No. & Length of lines SAN HS ' ON Total length/size FILTER BED ❑ Distance to nearest: PNM1E SN ALS oundation Property Line ENVIR SEEPAGE PITS I I Depth Size Number SUMPS 0 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: "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." Tht call for all required inspections. Complete drawing on reverse side. Signed X Title:/`tlAs;sAT L ^��AC�� Date: OR TMENT USE ONLY !� Application Accepted by L`<� Dat s*�-J / Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca a23-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE gMOUNT DUE AMOUNT REMITTED INFO CASH RECEIVED BY DATE PERMIT NO. . EH 13111REV,lixsl 9,Q(] �j/ /]�_'Co EH 1414 / 'f`}✓-r / `� LJ