ARCHIVED REPORTS_FIELD NOTES AND PERMITS THROUGH 4_4_1997

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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY \��` P.O. Box 2009 \ fn � 1 (1601 East Hazelton Avenue) dil ` JStockton, California 95201(((JJJ�� \�J PERMIT EXPIRES 1 YEAR FROM DATE ISSUED W^o N (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install;he Woik'hrle�iG. c�c�i6ed. This application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and t'he Rpler:and egulations of the San Joaquin Local Health District. Job Address Linco Ln ViLLage Center city Stockton Lot Size PM Owner's Name Lincoln Properties Address 628 Lincoln Center Phone 209/478-9200 Contractor PC Exploration Address 1780 Vernon St—, Suite Fticense No.265556 Phone9l6/783-9733 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES > Sn if, DISPOSAL FLO. NA PROP. LINEi Sfl. ft FOUNDATION AGRICULTURE WELL _NA_ _ OTHER WELL1nn fr PITS/SUMPS j1((_ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom El Manteca Dia. of Well Excavation 10Dia. of Well Casing 4" ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of CasingScheduLe 40 PVC Specifications '3 CII Ll Delta De 50 ft Type Grout Depth of Grout Seal ype orou f"1 Public Other �W�$gs P cement — I I Irrigation Approx. Depth I I Eastern Surface Seal Installed by PC Exploration _ Repair Work Done ❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material I8elow 50'1 -- TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 1 I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other 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. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size _ Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 Local Health Di§trict. Home owner or licensed agent's signature certifies 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 or sub-contracting 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 California." The applicant m call for all re uire s coons. Complete drawing on reverse side. q p Signed x7� Title: Vice President. Project Mgr. Date: �ry �yo� FORD RT SE ONLY Application Accepted by ��, � Date Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca a23-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEEgMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERIAWNO. INFO CASH r EH;4.28 3 24 IREV.r r x 51 EH 14 7a