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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 IRES 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 vork herein described Tris application is made in c=wliance with San Joaquin County Ordinance No 549 and 1862 and the Rules and Regulations of San ' Joaquin County Public Health Services job Address J 530 East Market Street C,,,Stockton hot bite/Acreage 1 Owner Name Stockton Newspapers,_IncA tikes, 530 East Market Street Phone(209) 546-8249 Spectrum Exploration, Inc 2365 Wigwam Drive, Contractor Add res s-5tockton _ JCA 95205 _License No 512268 Phone(209)465-8712 TYPE OF WELL/PUMP NEW WELL ❑ WELL REPLACEMENT i r DESTRUCTION �0 Out of Service Well 0 PUMP INSTALLATION 0 SYSTEM 8EPAIR -- OTHER ❑ monitoring Well DISTANCE TO NEAREST SEPTIC TANK SEWER LINES DISPOSAL FLD PRP 5 OIf,IEBOCIn]5) FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS i Industrial ❑ Open Bottom a Manteca Dta of Well Excavation – nC e5 Dia of Well Casing none Domestic/Private 0 Gravel Pack L7 Tracy Type of Casing_ none Specifications Public fk}Other fR Delta Depth of Grout Seal max. 20 feet Type of Grout cement Irr,Uai,on — ApprRx Depth I I Eastern Surface Seal instalied by Repair Work Done U Type of Pump H P __ State Work Done _ Well Destruction 0 Well Diameter Sealing Material i Depth rpment Depth Filler Material i Depth TYPE OF SEPTIC WORK NEW INSTALLATION � I REPAIR/ADDITION i i DESTRUCTION I I INo septic sysiam permuted if ptiblic sower is available within 200 teat 1 Installation will serve Residence` Commercial_ Gdrer Number of living units Number of bedrooms Character of sod to a depth of 3 feet Water table depth SEPTIC TANK ❑ Type/Mfg Capauty No Compartments ' PKG TREATMENT PLT ❑ Method of Disposal Distance to nearest Well Foundation Property Line LEACHING LINE ❑ No S Length of lines Total length/size FILTER BED n Distance to nearest Well Foundation Property Line SEEPAGE PITS fl Depth Size Number SUMPS Ll Distance to nearest Wel! Foundation Property Line DISPOSAL PONDS ❑ 1 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 of licensed agent s signature certifies the following I cavity that in the performance of the work for which this permit is issued I shall not employ any person,n such manner as to become subfect to workmen 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 st call for all required inspections Complete drawing on reverse side ' Signed X_/ X Title t -C�o J r ( 4C r+n-y✓ Date I/� ((7'L FOR DEPARTMENT USE ONLY Application Accepted by Date Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments Appiiiant - Return all copies to San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San loaquin P O Box 2409 Stkn, CA 95201 ' FEE AMOUNT DUE AHtpUNT REMITTED CK RECEIVED BY INFO CASH DATE PERMIT NO PSRpr 7?,