FIELD DOCUMENTS AND WORK PLANS 1991

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• APPLICATION FOR PERMIS SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3 P O BOX 2009, STOCHTON, CA 95201aD PERMIT UEIRES 1 YEAR FROM J U N 1 0 1991 (Complete in Triplicate) ENVIRONMENTAL `///1HEALTH Application is hereby sade,to San Joaquin County for a permit to construct and/or install t P vor'k'(betliPWJ"16d. This application In made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. 30+ Acres 66202 Lot Size/Acreage Job Address 150 N. Sinclair Avenue City Stockton - 66202 Owner's NameMarleV CoolinC Tower CO. Address 59110 Fnxri eigp rir Mission, K4 Phone 913 62-1818 85284 ContractorLayne Environmental Address9002 S. Hardy, Temne_A2 License No. 600469 Phone - TYPE OF NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER Z Monitoring Well C, DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP, LINE (See Figures 1 and 2) FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS (See Figures 1 and 2) F Industrial ❑ Open Bottom Cl Manteca Dia. of Well Excavation Dia. of Well Casing I Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications Public I l Other FI Delta Depth of Grout Seal Type of Grout I Irrigation _Approx. Depth I I Eastern Surface Soul Installed by Repair Work Done ❑ Type of Pump H,P. State Work Done — Well Destruction ❑ Wall Diameter Sealing Material a Depth Depth Piller Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will some: Residence_ Commercial_ Other Number of living unite _ 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. i Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Lina SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS Cl 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 County 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 subcontracting 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?compensa tion laws of California." The applicant must call for MI required inspections, Complete drawing on reverse side. Signed K Title: Date: FOR DEPARTMENT USE ONLY Application Accepted by Date Area Pit or Grout Inspection by Date Final Inspection by Data Additional Comments: _ Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 INFCK O AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO • EH 1}2x IREV. ve'L EH '.42e