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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 Fribed. (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the k Oddplication 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 1405 South Fresno Avenue city Stockton Lot Size 25,000 ft PM 400 South Fourth Street owners Name Pet Incorporated Address St Louis, MO 63102 Phone (314)621-5400 2140 Eastman Avenue C-57 Contractor McClelland ConsultanUress Ventura, CA 93003 License No._L560 15 Phode805)644-5535 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION= PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private gravel Pack ❑ Tracy Type of Casing Specifications ��77 f'I Public ❑ Other ❑ Delta Depth of Grout Seal Type of Grout/,7tp Sys I Irrigation _.Approx. Depth I I Eastern Surface Seal Installed by L�ti7�'.ii7C _ Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction }fes Well Diameter 2rt-411 Sealing Material (top 501 Depth 25-35 ft Filler Material (Below 501 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 serve: Residence_ Commercial_ Other Number of living units: _ 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. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS ❑ 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 D13trict. Home owner or licensed agent's signature canities 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 forall,rei uir d ins tions. Complete drawing on reverse side. Signed X ( s � Title: V/ �— 0red; Date: JIJ1�'a ngq EP NT USE ONLY L Application Accepted by l✓vz Date / /(J �CO � Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Sik 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Sarvices 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY INFO CASH DATE PER MIT'ry0. . EH 1}I41REV.I i x 51 EH 1420