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.�. APPLICATION FOR PERMIT ,.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZE T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Completeate) Application is hereby made to the San Joaquin Local Health District for a p mit onstruct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No.549 for sewage or 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 f t 2 PM 400 South Fourth Street owner's Name Pet Incorporated Address St Louis, MO 63102 Phone (314)621-5400 2140 Eastman Avenue C-57 Contractor McClelland ConsultayVWress Ventura, CA 93003 License No. 5 560 15 Ph,4805)644-5535 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTIONXINIX 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 LI Domestic/Private X5dyGravel Pack ❑ Tracy Type of Casing Specifications II Public ❑ Other (-1 Delta Depth of Grout Seal Type of Grout I I Irrigation ___ Approx. Depth I I Eastern Surface Seal Installed by /"��!�l� •�� _ �_ Repair Work Done 11 Type of Pump H.P. State Work Done Well Destruction Aj X Well Diameter 211-411 Sealing Material (top 501 V Depth 25-35 ft Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) \ n Installation will serve: Residence_ Commercial_ Other V, Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK 17 Type/Mfg ff ff No. Compartments PKG. TREATMENT PLT. Ll Method of Disposal Distance to nearest: Well Foundation Property Line V) LEACHING LINE Ll No. & Length of lines Total length/size C FILTER BED Cl Distance to nearest: Well _ Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS U 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 Di§trict. 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." The applican must call for I requir d ins tions. Complete drawing on reverse side. q ' � l Signed X Title: V,\CU 11 V red; 11-2 X13 �R"� NT USE ONLYc7 Application Accepted by ��_�- l Date � " (f7 Application Area Pit or Grout Inspection by Date Final Inspection by Date 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 INFO AMOUNT DUE AMOUNT REMITTED CK H RECEIVED BY DATE PERMIT NO. . EH114-M -21(REV.riNs) EH I�--� Ql� �Ibl9� 190 -9-71