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APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERZICES Soil Borings <br /> ENVIRONMOTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 Maximum Depth 11 ft <br /> p O BOX 2009, STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete In Triplicate) <br /> Appliestlon is heieby'rsade.to San Joaquin county for a pe <br /> rmit to construct and/or install the work her <br /> des tions s <br /> of San <br /> application is made in cc�liance with San Joaquin County Ordinance No. 519 and 1862 and the liaise and Regula <br /> Joaquin County Public Health Services. <br /> City StCC� Wt Size/Acreage ADDrO�.r4 �C:r S <br /> Job Address �947888 S. Figueroa St _ <br /> nasi P rA 9(11� Phone <br /> owner's Nam.Santa FTits <br /> Fe Pacific Pipe l ine Address - <br /> 2825 E. Myrtle St. <br /> ..von License No. 517�Phone <br /> Contractor $pectrllm FxDlOratlon_Address DESTRUCTION U Out of service Well ❑ <br /> NEW WELL ❑ WELL REPLACEMENT ❑ OTHER iionitoring Weil ❑ <br /> TYPE OF WELL/PUMP: SYSTEM REPAIR ❑ <br /> —��- PUMP INSTALLATION ❑ N/A PROP. LINE NLA <br /> (7) Soil BOrin S SEWER LINES N/A�- DISPOSAL FLD. *T/ <br /> ilii OTHER WELL IQ PITS/SUMPS 1A <br /> DISTANCE TO NEA EST: SEPTIC TANK N/A AGRICULTURE WELL N/A <br /> FOUNOATION <br /> INTENS TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS pia. of Wall Casing <br /> ❑ Open— Bottom U Manteca Dia. of Well <br /> Excavation SpecificationsLlIndustrial ❑ Tracy Type of Casing <br /> Type of Grout <br /> ❑ Oonleatic/Private Li Gravel Pack fl pelta Depth of Grout Seal �--� <br /> I'I Public ❑ Other <br /> Surface Seal Installed by <br /> I I litigation Approx. Depth I I Eastern State Work Done <br /> Repair Work Dona U Typeof Pump H.P.Sealing Naterial i Depth <br /> IWO.Destruetien ❑ Well Diameter'� Piller Naterial i Depth <br /> Depth <br /> available within 200 Isar.) y\ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/AOOITION I l DESTRUCTION I I INo septic system permitted if public suwer ut <br /> installation will verve: Rrnidenu <br /> Commarcisl_ Other <br /> Number of living units: <br /> Number of bedrooms Water table depth <br /> Character of veil to a depth of 3 feet: Capacity No. Compartments <br /> SEPTIC TANK. ❑ Type/Mfg Method of Disposal <br /> PKG. TREATMENT PLT. ❑ Property Line C <br /> Distance to naarert: Well <br /> Foundation <br /> Total length/size <br /> LEACHING LINE L1 No. d Length of lines Foundation Property Lim <br /> FILTER BED ❑ Distance to nearest' Well <br /> ;:umbar <br /> Sl:a Property Line <br /> SEEPAGE elTg ! ! Dept. Foundation <br /> SUMPS LI Distance to nearest: Well <br /> DISPOSAL PONDS ❑ <br /> I hereby conity that I have Prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws)+^ <br /> Aormance of the work for which this permit is issued, I shall not <br /> rules and requletiom of the San Joaquin County , nature <br /> Home owner or licensed agent's signature certifies the following:tto <br /> 't certify that in the Peis Contractor's Of <br /> employ'any pera0n in such man lteiat! the <br /> performance of the work aforwh ch this tpermit is issued,I s^hall employ Pereonsrfubject to worktmantaeompens+- <br /> certifies the toaowi <br /> tion laws of Calif isufre <br /> qd inspectwns. Complete drawing oTitle: rt reveraa side. 11/16/92 <br /> Date: <br /> The applicant c Project GeolOQlSt <br /> Signed <br /> FOR DEPARTMENT USE ONLY / <br /> Date �d ` �- Area <br /> 19 <br /> Application Accepted DY Dan <br /> ate -' <br /> I � Final Inspection by <br /> C� <br /> Ph or Grout Inspection by /' `� r <br /> Additional Comments: <br /> an oaquis County Public Health <br /> Applicant - Return all copies to: Environmental Health Permit/Serviceev ccs <br /> 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> IVED aY DATE PERMIT'NO. <br /> FEERjVffjt2jM <br /> 3 ��INFO � � I[st <br />