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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described This application is made in compliance vith San Joaquin County Ordinance No 549 and 1862 and the Rules and Regulations of San Joaquin cOti y tlfc V Ser eaeby Market, Stanislaus, Job AddressWashington, and American Streets C,tystockton Lot bite/Acreage Owners Name City of Stockton Address u25 North El Dorado Street Phone 209 937-8538 Spectrum Exploratimn Inc. 2365 Wigwam Drive (209) 465--8712 Contractor Address�tockton, CA 95205 License No T1 Phone TYPE OF WELL/PUMP NEW WELL 0 WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR 0 OTHER X1 Monitoring if 11 ❑ (soil Borings 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 173 Industrial O Open Bottom 0 Manteca Dia of Well Excavation 2 Inches Drs of Well Casing none r-) Domestic/Private 0 Gravel Pack 0 Tracy Type of Casing_ nolle Specifications I ) Public E'kOther (boringsjRDelta Depth of Grout Sealmax. 50 feet Type of Grout cement I 1 Irrigation —Approx Depth I I Eastern Surface Seel Installed by Repair Work Done U Type of Pump H P State Work Done_ Well Destruction ❑ Well Diameter Sealing Material a Depth cement Depth Filler Material It Depth TYPE OF SEPTIC WORK NEW INSTALLATION r I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is avertable within 200 teat 1 Installation will serve Residence— Commercial_ Other Number of kvrng units Number of bedrooms Character of sort to a depth of 3 feet Water table depth SEPTIC TANK 0 Type/Mfg Capactty No Compartments _ PKG TREATMENT PLT © Method of Disposal Distance to nearest Well Foundation Property Line LEACHING LINE Cl No 3 Length of lines Total length/size FILTER TIED 11 Distance to nearest Well Founaation Property Line SEEPAGE PITS II Depth Srze T Number SUMPS LI Distance to nearest Well Foundation Property Line DISPOSAL PONDS 0 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 a signature certifies the following I certify that rn the performance of the work for which this pempt is issued 1 shall not employ any person in such manner as to become subject to workman s compensation taws of California Contractor's hiring or sub-contracting signature certifies the following 'I certify that in the performance of the work for which this perrinit is issued I shall employ persons subject to workman's compenss tion laws of Californre �� pp The appicant must call for all required inspections Complete drawing on reverse side rte. JA-7 4S) ASigned X _ Title J / pets 6 S4 . FOR DEPARTMENT USE ONLY Appitcation Accepted by Date Arse Pit or Grout Inspection by Date Final Inspection by Date Additional Comments Applicant - Return all copies to San Joaquin County public Health Services Environmental Health Permit/Services 445 R San Joaquin, P O Box 2009, Stkn, CA 95201 IFEENFO AMOUNT pt1E AMOUNT REMITTED C K" RECEIVED BY DATE PERMIT NO