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xAPPL"YCATION FOR PERMIT i PAYMENT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES RECEIVED ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 MAY 15 1990 P O BOR 2009, STOCKTON, CA 95201 I EXPIRES 1 YEAR FROM DATE ED ENVIRONMENTAL HEALTH '2, ( plete in Triplicate) PERMITISERVICES Application is hereby made,to San Joaquin Couny 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. PPy 253-15-001 Job Address S•Tracy Blvd. approx. 1/2 ,M!. S. Of 530 City- Tracy Lot Size/Acreage 239 A. I Owner's Name Frank Zucca Address 1608 Lafa ette St. Alameda, CAphone 415 865-6839 cont{actor Granite �ns�ruc �j911Address POB 151 ,Stock�on,CA9520lLicense No, 89 Phone 982-4750 TYPE OF WELL/PUMP: NEW WELL © WELL REPLACEMENT.,D DESTRUCTION ❑ out of Service Well Ll PUMP INSTALLATION ElSYSTEM REPAIR ❑ OTHER ® Monitoring Well ❑4 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 SPECIFICATION n Industrial ❑ Open Bottom 0 Manteca Dia. of Well Excavation Dia. of Well Casing C.I Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications i1 Public 1-1 Other n Delta' Depth of Grout Seal Type of Grout I Irrigation _Approx. Depth l I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done w Well Destruction ❑ Well Diameter Sealing Material & Depth Y Depth +- an, Filler Material & Depth Q TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION 1-1 lNo septic system permitted if public sewer is awe available within 200 feet.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. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size g fFILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 subcontracting 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 appli?dn—Vinust call for all 3111qutV inspectio s. Complete drawing on reverse side. Signed X Title: Z4(W-- Date: _1J___hr J-d C F D ARTMENT USE ONLY ` Application Accepted by Date "' r Area Pit or Grout Inspection by Date Final Inspection by, Date Q f Additional Comments: Applicant – Return all copies to: San Joaquin County Public Health r ! Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE AMOUNT DUE 1 AMOUNT REMITTED CASH RECEIVED 9Y DATE PERMIT N0. INFO �7 I . EH13-24(FIEV.1/na)