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P APPLICATION FOR PERMIT SAN JO&QUIN COUNTY PUBLIC HEALTH SI CES ENVIRONMENTAL HEALTH DIVISION cm ,q -=. 1 si- X , 445 N SAN JOAQUIN, PHONE (209)468-3420 :1 "!4� P 0 BOX 2009, STOCKTON, CA 95201 1 <'i k PERMIT EXPIRES 1 YEAR FROM DATE ISSUED SER 0 $ 1992 (Complete in Triplicate) ENVIIR�OpfN��tMTE(N�T[IA�1�/HEALTH Application is hereby made to San Joaquin county for a Permit to construct and/or install the vorklbiRkA1T,/- LStle16[`+&, application in made in compliance with Ban Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. _ Job Address Parcel south of 3515 Navy Drive C. Stockton tot Size/Acreage approx.6 acres 511 N.3rookhurst Street w r s Name Shell Oil Company Address Anaheim,CA. 92803 Phone (714)520-3389 o(i�l Harding Lawson Associates 200 Rush Landingg Road,Novato,CA.537366 (415)892-0821 t4dnYract-West Hazmat Drilling Address 323'ritzgerald,Rancho CoE�999NO. C57=554979Phope(916)638-72 TYPE OF WELL/PUMP: NEW WELL a' WELL REPLACEMENT n DESTRUCTION ❑ Out or service Well Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR 11 OTHER ❑ NioDISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE apprcxlmate FOUNDATION r AGRICULTURE WELL OTHER WELL 60 �• PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS s Dia. of W 4 inches Cl industrial ❑ Open Bottom G Manteca Dia. of Well Excavation ell Casing Type of Casing PVC Specifications n F.1Domestic/Private Gravel Pack El Tracy g a ,.ox• 8ft• ement-bento I'1 Public fl Other Gravel Delta Depth of Grout Seal pp' Type of GroutC I I InitIatitm _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of PumpH.P. State W rk Done - Well Destruction ❑ Well Diameter lnc:.es Sealing wterial i Depthcement-beatOnite uprox. t. Depthapprox. 30f=. Filler Naterial A Depthclean fine sand approx, 8-30 ft. TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIR/ADDITION I I DESTRUCTION I I (Noseptic shin system perm tted if public sewer is availInstallation will ssnn: Residence— Commercial— Other Number of living units. _ Number of bedrooms Character of so to a depth of 3 lest: Water table depth SEPTIC TANK- ❑ Type/Mfg Capacity No. Compartments 1� PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line nn LEACHING LINE ❑ No. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Lim SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that 1 have prepared this application athat the work will be done in accordance with San Joaquin county ordinances, state laws, end nd rules and regulations of the San Joaquin Count Home owner or licensed agent's signature 01i _ g: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any Person in such manner as to - tbi�1?!kman's compensation Jaws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in t _ 'oFiM work for which this permit is issued, I shall employ persons subject to workman's compenw- tion laws of California." zt�' ' r . The a '!. The applicant must call or all required s s tiorle_ComPleto era mg on rover" side. rT. ' Senior Hydrogeologist Date: 8-26-92 Signed J EPARTMENT USE ONLY q FO [ - L\F 9 1� l _ �/Q' C✓R.GtJ(�C�ti� Application Accepted by r%ADate Area G Pk or Grout Inspection by Date Final Inspection by Data 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 AMOVNT REMITTED CAIf SH RECEIVED By DATE PERMIT'NO. ✓J 6 INFO L/[ • EN 1128 IeEV.1/x51 C C l EM tr.>e