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0 APPLICATION FOR PERMIT • ff SAN JOAQUIN LOCAL HEALTH DISTRICT PAYMENT 1601 E. HAZELTON AVE., STOCKTON, CA RECEIVED Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED OCT 3 1989 (Complete in Triplicate) ��RI��NM �TT{{.lI Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the.ENk rI�gIQ�Qg(N �L�pISaCetion is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules��rrrff�r�ddJJII--WW''��bFFaa77 b San Joaquin Local Health District. Job Address Sharpe Army Depot— 940 T�►1 ��1 city Lathrop Lot size PM Owners Name Department of Army Address 650 Cadtol Mall , Sacramento Phone Contractor Be-ylik Drilling, InC Address 3429 Longview Drive License No. 306291 Phone 2 TYPE OF WELL/PUMP: NEW WELL N WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION IN SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION 500 t AGRICULTURE WELL _91—a OTHER WELL n a PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 8" ❑ Domestic/Private N) Gravel Pack ❑ Tracy Type of Casing steel Specifications ['I Public Monitor fI Other F1 Delta Depth of Grout Seal 50 Type of Grout sand/cement I 1 Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Bey] i k Dri 11 i n0 Inc_ Repair Work Done ❑ Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filter Material l8elow 501 __ a 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 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 L1 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 D13trict. 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."Contractors 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 must call for all required Inspections. Complete drawing on reverse side. Signed k-&ML14 2 � Title, Project Manager Date: 9-27-89 David S. Bardsley elf R D MENT USE ONLY Application Accepted by Date Pit or Grout Inspection b Date �� L6_ Final Inspection b Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Service! 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIV!D0V OA7E PERMIT'NO. INFO H ♦ EH 14-26 .rixsl &`1 1-�71