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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION t 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 trade in compliance vith San Joaquin County Ordinance No 549 and 1862 and the Rules and Regulations of San Joaquin. County Public Health Services. Job Address 530 East Market Street CttyStockton Lot bize/Acreage Owners NameStockton Newspapers, Inc Address 530 East Market Street Phone(209) 546-8249 ' Spectrum Exploration, Inc. 2365 Wigwam Drive (209) 465-8712 Contractor Address-Stockton, CA 95205 License No 512268 Phone TYPE OF WELL/PUMP NEW WELL ❑ WELL REPLACEMENT F1 DESTRUCTION ❑ Out offp 1Service Well Cl PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER )J (SO[I n for N, Weil ❑ DISTANCE TO NEAREST SEPTIC TANK SEWER LINES DISPOSAL FLD POOP LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 'I Industrial ❑ Open Bottom ❑ Manteca Dia of Weil Excavation Ora of Well Casing Wane r) Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing— none Specifications I I Public �(I Other CK Delta Depth of Grout sear max 20 ft Type of Grout ' I I Irrstlation Approx Depth I I Eastern Surface Seal Installed by Repair Work Done LD Type of Pump H P State Work Done_ Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIR/ADDITION f f DESTRUCTION I I INo septic system permitted if public sewer Is available within200 feet 1 installation will serve Residence— Commercial_ Otfier ' Number of living units Number of bedrooms Character of soot to a depth of 3 feet Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No Compartments PKG TREATMENT PLT 0 Method of Disposal Distance to nearest Well Foundation Property Lina LEACHING LINE C1 No b Length of linea Total length/stze FILTER BED ❑ Distance to nearest Well Foundation Property Line SEEPAGE PITS 11 Depth Size — Number SUMPS LI Distance to nearest Well Foundation Property Lone 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 rules and regulations of the San Joaquin County and Home owner or licensed agent s Signature certifies the following I certify that in the parlormance of the work for which this permit Is Issued I shall not ' employ any person to such manner as to become subject to workman s compensation laws of California Contractors 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 compenta tion laws of California The applicant must tail for all required inspections Complete drawing on reverse side Signed i(— f' El-n Title C `-C�r- I (r u t'•.�.P�f71/ �G' Data FOR DEPARTMENT USE ONLY Application Accepted by Oate Area Pit or Grout Inspection by Date— Final Inspection by Date Additional Comments Applicant - Return all copies to Sao Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED ' INFO CK a RECEIVED BY DATE PERMIT ND CASH Page 13C tNYsV 4rw5+