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I SAN 104UIN COUNTY PUBLIC HEALTH VICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 i P 0 BOX 20091 STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED i (Complete in Triplicate) Application is hereby made to Sao Joaquin County for a permit to construct and/or install the vork herein described. This application 16 made In complianc6 with San Joaquin County Ordinance No. 549 and 1$62 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 7810 Thornton Rd. City . Stockton Lot Slie/Acreage j Owner's Name Valley Commercial SelrtkAddeess - Phone ' �'. t .l + �•, r,t ', ._��:� • t � -j f: j': �Ii_c11:€^�'1AG17.,$i�Y,r.�'A-•«�99,1$___�„�., •. Contractor A i:dti0n Address 799 -_ - _T License No: :1 f, .�� Phone. ,�15 �26--7 00 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT CT DESTRUCTION Cl Out of 9 rvice Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR O OTHER P Monitoring Well C1 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PRA..�f41 borings wil h one FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SU PSffydCOE]L1nCh 20 Scutp INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS le n Industrial 0 Open Bottom ❑ Manteca Die. of Well Excavation Dia. of Wail Casing f i Domestic/Private CI Gravel Pack ❑ Tracy Type of Casing_ Specifications J 11 Public I-) Other (I Delta Depth of 610441 gul 7ypa or trout f I I Irrigation Apprdx. Depth I I Eastern Surface Saul Installed by Repair Work Done 0 Type of Pump H,P. State Work bone Well Destruction © Well Diameter Sealing YAterial'l.Depth Depth Filler AstCrial 1 Depth � TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITiON`I k DESTRUCTION I I t o`saptic systilm pa#milted it public sewer is avdllable.withln 200 feef.I Installation will servA: Residence— Commercial_ Other Number of living units: Number of bddroom! Character of soil to a depth of 3 feat: -_ r ° Whist tabib depth SEPTIC TANK f( ❑ Type/Mfg „�__ Capacity No. Compartments PKG. TREATMENT IyLfi.0 Method of bisposal Distance to nearest: • Well^ Fouhdation Proper1yoLine } LEACHING LINE Ll No. A Length of linea Total lengthlsixe I FILTER Ski) .. n Dlstance to nearest. Well Foundation Property Line•• '�_ SEEPAGE PITS 1 1 . Depth Sire + — Number SUMPS $ - LI Distance to nbaresl: Well Foundifion Property Lina DISPOSAL PONDS ❑ f .. I hereby cenjfy that I have prepared this applicallon and that the work will bf8 done In accordance with San Joaquin cougty ordinances. state Iowa, an rules and regulations of the Sen Joaquin County Home owner or licensed agent's signature cenifiis the following: "I certify thal in�thb p$riormance of the work for which this permit is issued, I shall not employ any person In such mariner as to become subject to workman's corrlpapaatlon lava of California." Contractor's hiring or nub-conlracting signature cenifies the following: "I certify that in the performance of the work for which.'this peimlt is issued,I shall employ persons subject to workman's compensa- tion Iowa of California. i The applicant must call for all tequlred Inspeciions. Complete drawing on t6veome side. 40 Signed X Title: ate: 404 DEPARTMENT USE ONLY fC? 'k Application Accepted by. Dald res Pit or (;rout Inspection b;;. Date Final Inspection by Date I` Additional Comments: Applicant - Return a14 copies to: Ban Joaquifi County Public Ilealth Sdrvices j Environmental Health Permit/Services lam✓, 445 N-3an Joaquin, P O Boz 2009, 5tkn, OA 95201 Sa 8 try�aE ��ldltLED CK D BY T[i• Mir N*, �) i EH t324IREv,t/A$t `! LN t1 7a E 1