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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)46$-3420 P O BOR 2009, STOCKTON, CA 95201 VIA JOB 20-3574-01 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) SSS-t7?0-Zr Application in hereby toads to San Joaqulu County for a permit to construct wnd/or install the Work herein described. Th16 application is made in cotpliarce with Sam Joaquin county Ordinance No. 5L9 and 1862 and the Rules and Regulations of San Joaquin county Public Health Servleee. APN .#055-070-14 GRAIN STORAGE TANKS 11GBW_,k �12;,WEST OF I-5 airy tar Sizc/Acreragel Job Address fp�''��• S7�f4a T SGA!/ Owner's Name KLEIN BROS • LTD. Address 1305 W.FREMONT ST. ,STOCKTON Phone Spectrum/Kle infelder address 28z5 I;. tfyrtle Street Lhense rvo. 512268 Phone 948-1345 Co�udttor TYPE OF WELL/PUMP . NEW WELL ❑ WELL REPLACEmEhiT 1-1 DES'RUCTtON{�-0ut.aLSacvLea Laid-�I PUMP Ik1STALLAT10N ❑ SYSTEM REPAIR C OTHER (hS ?166ytrlr3agrdalL [� DISTANCE TO NEAREST; SEPTIC TANK SEWER LINES ,_ DISPOSAL FLD,_ PAOf'-ttMt 3 Teat Bor 20' -40' De ngs FOUNDATION AGRICULTURE WELL OTHER WELL PiTSOSOMPrI t7 INTENDED USE Dia TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS No GW N 7 Industrial Cl Open Bottom V Manteca Dia of Well Excavation 9.4 -of iNr-11 -09r"T(pV P' ate7 antic! Cl DomesuclP(vate sveelil C1 Grave! Pock r 1 Tracy Type of Casing_- .. o+*s If GW I I Public C ' Other 1-1 Delta Depth of Grout Seal Type of irevt eIlcountered,will k, I 1 Imudtron A ro><. Depth I I Eastern Surface Seul installed by — Approx. backfill with Repair Work Done L -J Type o1 Pump H P State Work Done _ it hole Plug" Sling Material i Depth ea � Wail Destruction O Well Demeter Depth Filler Material i Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIRIADOITION I i OESTRUCTION 111No septic system permitted if public sewer is available within 200 feet. f Inatallatten wilt serve Residence — Commercial _ Other Number of iivrng units: Number of bedrooms Character of soA to a depth of 3 feet: Water table depth SEPTIC TANK Q Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. 1) Method of Disposal Distancs to neere6l: well _ _ Foundation Property Line LEACHING LINE Lf No. & Length of lines Tara! lengthlsize_. FILTER BED IJ Distance to neatest'. Wes FounCation Property Line O SEEPAGE PITS t I Depth ___.Sirs Number [ - SUMPS L: Oistance to nearest: Weil Foundation Property Line ` CISPOSAL PONDS 0 hareoy certify that I have prepared this application and that the worn wd be cone or, eccoroance with San Joaquin County ord.nances, state laws, and rums and regulations of the San Joaquin County Home owner or licensed agent's signature certif.es the following: "I certify that to the performance of the work for which this permit rs issued. I shall not employ any person in such manner as to become subtest to workman's cornpenssUon laws of Califorrwa. Conuaclor's hiring or sub contracting signature certifies the fdlowrn -I certify that in the performance of the work for which this permit is issued. I shaft employ persons subject to workmen s compensa lion Jaws of Calif. ra ' The applIcam s 1 o uired in I o plats drawing on reverse side. ~ �• Title: Project Engineer Date: 3-19-92 Signed x - EP RTMENT USE ONLY q Application Accepted by -f ti _ Gate (� Area o I3 VfG ^s!jS ft1y"KS Jir�4&- Pit or Grout Inspection by Data Final Inspection by 1al4"_sJp Date AJo i�t/e D��'d f7r is .r Additional Comments Applicant - Return All copleS to: Sart'Joaquin County Publtc Health Svrv1C&P 6446 EnvL ronaental JEewlth Permit/Sorvicets 445 N San JoagUin, P O Box 2009, Stkn, CA 95201 EH 4124 (REV. ri 5) EH Il 26