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APPLICATION FOR PERMIT • SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby aade,to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance vlth Ban Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Ban Joaquin County Public Health Services. Job Address 3515 Navy Drive city Stockton Lot Size/Acreage approx.6 acres. 511 N. Brookhurst Owner's Nana Shell Oil Company Address Anaheim CA Phone 209-466-9213 P.O. Box 5993 ContractorSFS/Harding Lawson Address Vacaville, CA License No.C-57 58269$hone 707-451-921 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Yell 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 V4 ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing VI ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications- [1 pecifications SI Public n Other fl Delta Depth of Grout Seal Type of Grout I I litigation _.Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Tiller Material i Depth r, v TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feat.) .Installation will serve: Residence_ Commercial_ Other r' Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK. _ ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. d Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Lina SEEPAGE PITS If Depth Size Number SUMPS CI Distance to nseresC Well Foundation Property Line DISPOSAL PONOS ❑ 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's signature certibes 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 of subcontracting 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 Crilifornla„ The applicant must call for an uired ' ape Eons. Complete drawing on reverse side. signed x Title: Senior Geologist Date: 8/10/93 Bruce L. Wilcer f FOR DEPARTMENT USE ONLY Q Application Accepted by ��/-M��'4 Date (/ Area 4/�r'/s•i' C,s PN or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services 29 Environmental Health Permit/Services O / �� 0042 u,(y C/{ 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE INFO AMOUNT REMITTED CKCASH RECEIVED BY DATE PERMIT'N0. . EH U.74(REV.11-51 EH NOm