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APPLICATION i � SAN J�QUINCOUNTY PUBLIC HEALTH AIJVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 = P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE- ISSUED, (Complete in Triplicate) Application is hereby made.to San Joaquin County for a perm t to construct and/or install the work herein described. This application in made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. 445 West Weber Avenue City Stockton Lot Size/Acreage 2.5 Jab Address Stockton Savings 501 West Weber Avenue (209) Owner's Name Bank Address Stockton, A 95202 Phone - 6870 Kennedy/Jenks 303 Second St. , 10th Floor (415) GeMme! rCons ultants•-_ Address San Franrisco. CA_License No. Phone 243-2518 TYPE OF WELL/PUMP. NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION Cl out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER CX Monitoring onitor gVeil ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. j PROP. L&P FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Ci Industrial ❑ Open Bottom G Manteca Dia. of Wail Excavation Inc e5 Dia. of Well Casing none Cl Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing- none Specifications III Public X Other(borings)X Delia Depth of Grow Seal less than 15 ftrypa of Grout cement 11 Irrigation _Approx. Depth I I Eastern Surface Soul Installed by Repair Work Done U Type of Pump H.P. State Wor Done Well Destruction ❑ Well Diameter Sealing Material i Depth Cemen Depth Filler Material i Depth OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDITION i I DESTRUCTION I 1 INo sepric system permitted it public sewer ' available within 200 feet.) " Installation will Residence_ Commercial_ Other Number of living units: Number of.bedrooms Character of soil to a depth of 3 !ee . r table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments - PKG. TREATMENT PLT. ❑ 41 Method of Disposal Distance to nearest: Well ation Property Line i LEACHING LINE Cl No. & Length of lines I length/size -FILTER BED ❑ Distance ton Well Founaation r Line SEEPAGE PITSDepth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DIS L PONDS ❑ I 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 County Home owner or licensed agent's signature certifies the following: "I certify that in the performance of rhe work for which this permit is issued, I shall not employ any person in such manner as to become subject to workmen's compensation laws of California." Contra rti795 '� nature I` certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall emplo'7K par ns subject to workpensa- tion laws of California." +/ The applicant must call for all required inspection*. Complete drawing on reverse side. C Signed x �e^ � (RG #6153�itle: Hydrogeologist ate: NLY 41WXEPARTMENT lfSfi OApplication Accepted by NLI Date Area Pit orGrout Inspection by, Date Final Inspection by Date Additional�C m pts: �y t 1"Qum p0mN-��tC MALTH l Applicant - Return all copies to: San Joaquin County Public H097k37 � � rr Enviroftental Health Pc,.it/ 445 N San Joaquin, P O Box O I4. . 1Yyt?: I FEE INFO AMOUNT DUE AMOUNT REMITTED CA5H K t RECEIVED By OATE PERMIT'NO. Page IJf� . EN 13.241 REV.rinSr rota ��' �( �' o�m I L EH M.2a