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APPLICATION FOR PERMIT aSe. e SAN J•DIN COUNTY PUBLIC HEALTH gk SLICES r ENVIRONMENTAL HEALTH DIVISION AUG 3 1 1992 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 ENVIRONMENTAL HEALTH PERMIT/SERVICES PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application 1s hereby made,to San Joaquin County for a permit to construct and/or install the work herein described. This application SS made in compliance vith San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. 3515 Navy Drive City Stockton Lot Size/Acreage approx 6 acres Job Address Shell Oil Company Address 511 N. Brookhurst Street,A-lahei4hone 714)520-3389 Owner's Nauta °00 Pu Contractor sh Landing Road 537366 415)892-0821 Harding-Lawson ASSo. Address Novato; CA 949+7 License No. Phone TYPE OF WELL/PUMP: NEW WELL m WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Veil 0 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Yell DISTANCE TO NEAREST: SEPTIC TANKSEWER LINES DISPOSAL FLD. PROP. LINE approxlmate FOUNDATION -79_rt AGRICULTURE WELL 60 ft OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS L) industrial ❑ Open Bottom G Manteca Dia. of Well Excavation 1 lames Dia. of Well Casing 17 Domestic/Private N Gravel Pack G Tracy Type of Casing- [*] Public ❑ other n Dena Depth of Grout Seal approx. 8 f t Type of Grout car• n ' Vii-- I I litigation _Approx. Depth 1 I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done_ Wale Destruction ❑ Well Diameter 4 inches Sealing Material i Depth n-R Fes, Depth approx. 30 f-` Filler Material A Depth clean fine sand 8-30 ft. TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 1 I DESTRUCTION I I (Nailsbatic systithinem permitted if public sawer is Installation will some: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of sola to a depth of 3 test: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nation: Well Foundation Property Line LEACHING LINE ❑ No. 8 Length of lines Total length/size " in FILTER BED ❑ Distance to nearest: Wale Foundation Propefty Lm V •� 7 , N i SEEPAGE PITS 11 Depth Sue Numbers u„ SUMPS LI Distartce to nearest: Well Foundation PropsM Lini' DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this applicatb that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin C Home owner or licensed agent's signature '1 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 an's compensation laws of California." Contractor's hiring of sub-contracting signature certifies the following: "I certify that in 00 c w9 for which this permit is issued, I shall employ persona subject to workman's compenst tion laws of California." � II�i'',,,, ��l�l�,t� I. The applicant must call or all fequif tltlmi'•u Ar %te drawing on rover" side. f)(? � �_� q�an1 ' Signed his: n-o'- Rv of qt Date: 2-9F-1OGi Op F CALF DEPARTMENT USE ONLY q Application Accepted by ^` ' Date �Z' Area C-+PCO24V 2 Pit or Grout Inspection by Date Final Inspection by� Date 7Z/ / Additional Comments: Applicant - Return all copies to: San 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 SASH RECEIVED gy DATE PERMIT NO. INFO �7 C p l• LQ EN 13-24(REV. /mal ?Xt J Tic, 7 7 -1/