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SAN JAPPLICATION FOR PERMIT UIN COUNTY PUBLIC HEALTH SJOICES 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 with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 3515 Navy Drive City Stockton Int Size/Acreage ai)Drox. 6 acres. 511 N. Brookhurst Owner's Name Shell Oil Company Address Anaheim, CA Phone 209-466-9213 P.O. Box 5993 Contractor SES/Harding Lawson Address Vacaville, CA License No.C-57 582692phone 707-451-921 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well 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 ❑ Industrial ❑ Opan Bonom ❑ Manteca Die. of Well Excavation Dia. of Well Casing \/i. Domestic/Private ❑ Gravel Pack' ❑ Tracy Type of Casing_ Specifications I_v^_1l Il Public ❑ Other fT Delta Depth of Grout Seal Type of Grout \ I I Irrigation _.Approx. Depth I I Eastern Surface Seel Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction O Well Diameter East Ing Material a Depth Depth Yiller Material a Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 270 feet.) D. Installation will serve: Residence_ Commercial_ Other Number of Mang units: _ Number of bedrooms Character of sod to a depth of 3 teat: 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. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth She Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby comity 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 certifies the following: '9 comity that in the performance of the work for which this permit is issued, I shall not employ any person in such rtanneras to become subject to workmen's compensation laws of California." Contractor's hiring or subcontracting signature certifies the following: "I comity that in the performance of the work for which this permit is issued, I shall employ parsons subject to workman's compensa- tion Laws of California." The applicant must call for allJ°quired spa ns. Complete drawing on reverse side. Sipradx �-�w` Title: Senior Geologist Date: 8/10/93 `. I Bruce L. �Wii11l��cerr FOR DEPARTMENT USE ONLY Q Application Accepted byslttic Date U G Area �✓d2'%�� Ph or Grout Inspection by �1' �-�-e— Data`VS�;L& Final Inspection byr Data l/7 Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services 1yJ�J7 Environmental Health Permit/Services V l �/ f!i/I<'NJ 445 H Sen Joaquin, P O Box 2009, Stkn, CA 95201 (/ Q'CFEEa t3 INFO I AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. EH 1124(REV.I r•!) l r1/Z193 EH t4 25 t