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�� ✓ 'f Ar JOAQUIN LOCAL HEALTH DISTRI I GcIALy �Np�noa 601 E. HAZELTON AVE., STOCKTON, C v s-^ ' {� C Telephone (209) 466-6761 SEP 2 9 19Sg G� A PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) ENVP'Cit""�SJAL JAL Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work here"i described. This application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 540 W. Scotts Avenue City Stockton Lot Size PM Owner's Name Acme Galvanizing Co. Address 1655 - 17th Strear Phone - Oakland, CA G6 Go Interstate Soil Sempl Anaheim. CA '7 501384 Contractor Aosess 542 Atch inson- III KSx KK License No. Phone1 7 1 A 1 772- TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER O monitoring well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 10" Dia. of Well Casing ❑ Domestic/Private 19 Gravel Pack ❑ Tracy Type of Casing 4" d is ovd Specifications FI Public fl Other n Delta Depth of Grout Seal 0-201 Type of Grout-2 sack slurry I I Irrigation 4-0-Approx. Depth 1 1 Eastern Surface Seal Installed by H yd r o t e r h Cnn c u l tante _ Repair Work Done [J Type of Pump _X_1_ H.P. State Work Done _10/3/88 Well Destruction ❑ Well Diameter x Sealing Material (top 509 Depth _ Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION 1 I RFIVA i R,ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.I 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 Cl Type/Mfg Capacity No. Compartment PKG. TREATMENT PLT. ❑ Method of Dispv Distance to nearest: Well_ Foundation Property line _Cb W� LEACHING LINE ❑ No. & Length of lines Total length/size C Q FILTER BED ❑ Distance to nearest: Well Foundation Property Line!`Q SEEPAGE PITS I I Depth .Size __ Number �[ ^ SUMPS LI Distance to nearest: Well Foundation Property Line 4 i DISPOSAL PONDS ❑ _ ) 1 hereby certify that 1 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 District. Home owner or licensed agent's signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not k employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature {I 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 mall for all required inspections. Complete drawing on reverse side. Signed X ii Title: Project Genlogict _ Date: 9/22/88 Ant on Sapona ra FOR DEPARTMENT USE ONLY Application Accepted by ___._ Date �`� I/ a O Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2008, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. INFO ♦ EH 143a(REV.11.sl 51542 �1 1��1 E�7�