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f�- APPLICATION FOR PERMIT t_ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PA �f ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 Re 1601 a P O BOX 2009, STOCKTON, CA 95201 f 5 , PERMIT EXPIRES 1 YEAR FROM DAIE U AJ WIN t# UNT E3.,; ;, AIT y (Complete in Triplicate) 1RONlrjE N"rwid L H � eyP Application is hereby made.to San Joaquin County for a permit to construct and/or install the work herein dlescri�feD1Yhis application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 26500 Chri sman Road Trac City. -- .y ,,..__ hot Size/Acreage Owner's Name Defense Depot Tracy Address 26500 Chri sman Road Phone 209 832-9532 Contractor water Development Cor dress 220 N. Fast Street License No.283-326 Phon4916 662-28 9 TYPE OF WELLIPUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well Cl PUMP INSTALLATION O SYSTEM REPAIR.❑ OTHER 93 Monitoring Well X] DISTANCE TO NEAREST: SEPTIC TANK 100 ft SEWER LINES + 100 ft DISPOSAL FLD, PROP. LINE 'NA FOUNDATION AGRICULTURE WELL MOTHER WELL PITS/SUMPS n INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n C) Industrial ❑ Open Bottom D Manteca Dia. of Well Excavation -1 nC e5 Dia. of Well Casing - nC ;lVl C.] Domestic/Private & Gravel Pack 7� Tracy Type of CasingSChedUle 80 PUO Specifications SAP Attarhind 10\ j I'I Public C] Other ❑ Delta Depth of Grout Seal See Attached Type of GroutSee _Attached, ( A i I Ifrigation —_Approx. Depth I I Eastern Surface Seal Installed by �J 1 Repair Work Done ❑ Type of Pump [Mane H.P. State�hlork�pr�� Weil Destruction ❑ Well Diameter 4--inch Sealing Material & Depth JJ tt tt HH II `t HH Depth Filler Material & Depth SEE ATTACHEDO 7YP PTIC WORK: NEW INSTALLATION [ I REPAIRJADDITION I I DESTRUCTION I I Wo septic system permitted if public sewer is II ` Installation will serve: ' nce^ Commercial_ Other available within 204 feet.) Number of living units: Nu of bedrooms Character of soil to a depth of 3 feet: er table depth1�y'\ SEPTIC TANK. 0 Type/Mfg Capacit No. Compartments \, PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundati Property Line LEACHING LINE_ ❑ No. & Len lines Total len as J FILTER BED ❑ ce to nearest: Well Foundation Property SEEPAGE PIT I I Depth Sire Number SUMPS Cl Distance to nearest: Well Foundation Property Line DIS SAL 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 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." Contractor's hiring or sub-contracting signature A 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 X � �.,,� ..._� Title: Date: 1990 EP 7 USE ONLY '� Application Accepted Date res 157 Pit or Grout inspection Date Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health s Services, Environmental Health Permit/Services 1 1601 E. Hazelton Ave., P 0 Box 2049, Stockton, CA 95201 FEE CK INFO AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMl7'NO. CASH t . EH IA-2s 2�IREV.FiHSY X35.00* EH;i3S NS3 z- � * ADDITIONAL 35.00 PER HOUR WILL BE BILLED FOR EXTRA VISITS APTDD rTDCT "� '�