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A y vw APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZETON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is heieby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is ulations of the San Joaquin made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump and the Rules and Reg Local Health District. Job Address 14800 W. Schulte City Tracy Lot Size PM Address 14800 W. Schulte Rd Phone 836-2949 Owner's Name Thermal Energy 14800 W. Schulte Rd 534198 Phone 836-2949 Contractor Tracy Constructors Address License No. TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FIL PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS ' INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Dia. of Well Casing Inustrial El Open Bottom Manteca Dia. of Well Excavation d _ ❑ Domestic/Private ❑ Gravel Pack O Tracy Type of Casing Specifications 1-1 Public Cl Other n Delta Depth of Grout Seal Type of Grout * _ I I Irrigation =-Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ ^, NZ i Well Destruction ❑ Well Diameter Sealing Material (top 50') f Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION 41 REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted-if public sewer is available within 200 feet.) (� r Installation will serve: Residence_ Commercial X Other f I Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: - Sandya Water table depth 132' SEPTIC TANK ❑ Type/Mfg - Capacity l '{) ^'% No. Compartments 2 PKG- TREATMENT PLT. ❑ Method of Disposal Distance to nearest- Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines 34 Total length/size 368/4110 i FILTER BED ❑ Distance to nearest: Well 300 Foundation 50 Property Line 3�0 1 SEEPAGE PIT /� I I Depth Size SO!KvZ _ Number.. SUMPSr,- ❑ Distance to nearest: Well 700 Foundation -- Property Line 200 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 Diltrict. 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,..]shall employ persons subject to workman's compensa- tion laws of California." ( The applicant must for all required i ctions. Complete drawing on rever side. t� Signed X 0 Title: � /� Date: _ Za !) l FOR DEPARTMENT USE ONLY _ Application Accepted by Data 241 Pit or Grout Inspection by Date Final Inspection by l Area Date �a 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 FEE AMOUNT DUE AMOUNT REMITTED CK H r3-J RECEIVED BY DATE PERMII'NO. INFO �7 n .S/1 � . GH .cv "', —7A_n t-) ' / - 11 n