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APPLICATION FOR PIMMIT GAN JOAQUIN LOCAL WEALTH DISTRICT 1601 E. HAZELTON AVE„ STOCKTON, CA : .r• Tals)Sllarie,(209)468;6701 . PERMIT X! :S 1 Y0~ARF#OIVI OATE'ISf1UED ICtxliplato in Tripficittal Application is 1VV6bkWWa to the San Joaquin Local Health 6:7ariet for a permit to comlruet std/or install the work horetn described,This application Is wi made in compkinceih San ticewn County Ordinance No.549 fu.s4wago w pro. 1@62 for wet pump and the Rules and Local Health Dissrke. Regulations of the Silosq Jouln ,6425 Pacific Avenue Stockton 7(260' Pm Job Addr'ess �• CIIY— ,Lot She 240' Owner's N.f, Wickland Oil Company Addraw 1'76; CUU&-*3 VhYr Sa rmlento, CA 9581;m,,.(916) 921-1100_ Conitactor VbStPxn 0�0 Address_1386 E• Ems_ St License No.513857 Phone (916) 662-4541 TYPE OF WELLIPUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ ,.SYSTEM REPAIR a OTHES ED M14t W.VAM DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER,LINES :SO• r•�01SPOSAL FL4. M1_ PROP.LINE 2 A_ FOUNDATiON _N/A AGRICULTURE WELL 9.r,_••OTHER WELL .p1TSlS P$ � INTENDED USE TYPES OF WELL PROBLEM AREA •,CONSTRUCT104 SPECIFICATIONS Q Industrial 0 Open Bott:,m ❑Mantes Dia.of Well Excavation 16" oia,of Wale(:salol., 4-- 0 "❑Dornsstic/Private IR Gravel Pack ❑Tracy Tv;b of C2sit+.g___E2C_ Specifications I.1 Public r1 Other 12 Delta Depth of Grout Sas[ --2Q!- Type of Grout Njaat girmt I 1 Irtil)mion 464 Approx. Depth I I Eastdrn Suds"Soot Instatied by Repan Work Done L3 Type of Pump -Njj__ H.P. Sesta 1Ywk Dana Won Destruction ❑ Wall Diameter 4" Sealing Material(top.Wl _ fh�Yrl;_�tm . Depth--- FS' Filter Material f8elow STJ TYPE OF SEP`IC WORK: NEW-1 NSrALLATION l I SEPAIRI.IDDITION.1 I DESTRUCTION I I (No saprie iystern permitted it public sewer in available within 20D feat.) i Insufflation wit(ssrve: Residsnce_ Commercial r Other Number of living units: Number of bedrooms Cfurectai AI wi!to s d►pth of 3 fMt: Water Cable daplh SEPTIC TANK 0 Type/Mfg Capacity No.Compartments PKG.TREATMENT PLT.❑ Msthorl of D sposal Distance to pearsst: won• Foundaiioit P - i topeity Lige LEACHING LINE Q No.8 Length of fins:. Tout iangth?sus FILTER BED C) Distance to nasrost: Well Foundation Property Lim SEEPAGE PITS 11 gepth Size Number SUMPS 1,1 D:sun"to noises_,: We" Foundation Property Lina DISPOSAL PONDS II r I hereby certify that I have prepared this application and that tho work wi4 be done it accordance with San Joaquincounty ordinances,stats fawn,and rulax and regulations of the San Joaquin Local Health Or'3lrict. Honor owner or ktinsad,agent's signature certifies the f6llowing:'I cafft that in the parformence of the v nrk for whkh this perm[t 6 issued,I shall not amploy ani person in wch manner as to become subject to wtokrttan's compsnaation laws of Cailfwttiu••'Comrsmen hiring w w b-contracting 60natun cer0ias the following;'i certify shat kI the paAormance of the wark for which this permit 6 lau.sd,I shall employ persons subjnet to xnrkman's campensa. tion laws of California." Tho applicant.n t can for eH 'ad inspections.Complete drsv*Cg on ta"m elle. Title: vine Pt'mjdmt1/11/89 Data: am-vE35 FOR DEPARTMENT USE:ONLY f (� Application Accepted b W. 1 ate' 041s��' -Area Pit of Grout Inapactio3 by Date Final IrspacWn by Additional Comments: �i Stk 468.8:'91 ❑Lodi 3693921 ❑Manias 873.7104 ❑Tracy 835.6385 pplksnt•Return all copies to:Env'uonmantal Health Few it/Services 1901 Cr.Houlton Ave.,P,O.Box 2OD9,Stk..CA 9=1 FEf AMOUNT DUE AMOUNT REMITTED K RECEIVED 8Y DATE PERMIT'NO. IWO CASH