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•�-.��} � r --�� _.mum "� . _ -A SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)46$-3420 al P 0 BOX 2009, STOCKTON, CA 95201 . PERMIT E%PIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made.to San Joaquin County for a permit to construct and/or install the work herein described. This 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 23500 E. CopperClpoliS Rd. _ CityFarmingto Lot Size/Acreage 440acres Owner's Name R & J DonderQ Address Phone Contractor Puryiance Dr,illt-rsTTngtress -P 0. Box 64,Linden License No. 377R� Phone TYPE OF WELL/PUMP: NEW WELL _0 WELL REPLACEMENT C1 DESTRUCTION ❑ Out of Servide'Nell=C.1 PUMP INSTALLATION SYSTEM REPAIR 0 OTHER ❑ Monitoring Well L7 DISTANCE TO NEAREST: SEPTIC TANK SEWERT ES— DISPOSAL FLD• PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ; n Industrial. - j7 Open Bottom ❑ Manteca Dia. of Well Excavation Dia of Well Casing 4 C Domestic/Private ❑ Gravel Pack ❑ Tracy _ Type of Casing_ Steel Specifications -2 s n Il Public er n Delta Depth o G a � �Q t-'Seal � e_ Type of Grout C t kl Irrigation pprox. Depth I i Eastern Surface Seal Installed by f Repair Work Done U pe of Pump turb H.P. 125 State Work Done Well Destruction ❑ Well Diameter Sealing Material & Depth rW Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION.LJ DESTRUCTION I I INo septic system permitted if public sewer is �! available within 200 feel l 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. O Type/Mfg Capacity No. Compartments _PKG. TflEAT11AENT P.L'TTC]""'�"✓ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines �? Total length/size' FILTER BED n Distance to nearest. Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number atSUMPS Cl Distance to nearest: Well Foundation Property Line }.DISPOSAL PONDS ❑ s l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state lawAandrules and regulations of the San Joaquin CountyHome 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 sh employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work fo► Bch this permir,is issued, I shall employ persons subject to workman's compensa- tion laws of California." The=applicant call f r all a 'red inspections. Cpmple=o drawing on-reverse side.' Sign Title: Corp. Secretary Date: 5/12/93 I R TiNENT USE ONLY y,[� Application Accepted by Date rea Z- N 4 l Pit rout spection by ate,��/ Final inspection by Date Z>� 3 Additional Comment>!_1r! a��,f✓ ff iS`p . p / } Applicant - Return all copies to: •San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 M. jNF� AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. J�J . EM 13.24 IREV.+i n 5l[ EM+4.26 c 7 z T� i