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SITES '112 SAN JOAQUIN RIVER CROSSING APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES I ENVIRONMENTAL HEALTH DIVISION P O BOX 2009, STOCKT9N-, -CA 95201 (209) 468-3447 ulot, PERMIT EXPIRES I YEAR rROM DATE ISSUED / � ,v(Complete ill Triplicate) Application is hereby made to Joaq n ounty 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 1662 and the Rules and Regulations of San Joaquin County Public Health Services. 1)DoC. No. 81063420 2)D .C. No. 900162 0 Job Address So ( ty �ot Size/Acreage N/A 1) L. Volpi 1) 1245 W. Walnut, Stockton CA , 1) (209)464-6768 Owner's Name 2 Address 2) 12355 W- S r:htt 1 t P,_Trar z _CA Phone466-7706 P.O. Box 50367 Contractor Pitcher Drilling Co Address Palo Alto. CZ, 94303 License No. 263085___Phone( 2 - TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT M DESTRUCTION ❑ Out of Service ife11 Cl PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well 1 � DISTANCE TO NEAREST: SEPTIC TANK _ 50' SEWER LINES 7 50' DISPOSAL FLD. > 50' PROP.-LINE ) 5W , FOUNDATION � -50' AGRICULTURE WELL _>r� OTHER WELL 750' PITS/SUMPS ?'50' -� INTENDED USE TYPE OF WELL . PROBLEM AREA CONSTRUCTION SPECIFICATIONS 11 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation _ F" Dia. of Well Casing " U Domestic/Private ❑ Gravel Pack I.❑ Tracy Type of Casing pyc Specifications SC.hPdAll P 40 4 D1 Public X1 Other cyDella Depth of Grout Seal 35' minimum Type of Grout Bentonite & 1 CI trngation 9-Q-L Approx. Depth n Tremmie Grout Cement_Eastern Surface Sea! Installed by.� - � Repair Work Done U Type of Pump H.P. State Work Dona Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIR/ADDITION 0 DESTRUCTION CI (No septic system permitted if public sewer is available within 200 leet.l Installation will serve: Residence _ Commercial_ Other Number of living units: Number of bedrooms Character of &oil to a depth of 3 feet: Water table depth { SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ 1 Method of Disposal Distance,to nearest: Well Foundation Property.Line r LEACHING LINE ❑ No. b.Length of lines Total length/size a FILTER BED la Distance to nearest: Well Foundation Property Line 4. SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ t 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: '•t canify 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 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• tlon laws of California." The applica t c I required spections, Complete drawing on reverse side.- / 1 Signed Title: l cld 46 t4 Geol%,sc l�+cees-{ Date: + 6 IliFOR EPARTMENT USE ONLY `� [� Application Accepted by Date c Area P Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: 1 — Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P 0 BOX 2008, STOCKTON, CA 85201FEE � INFO CK AMOUNT DLE AMOUNT REmfTTED ECASHRECEIVED BY DATE PERMIT'NO. EH 13.241AEV.t/ASS � d ! �+� 1 �(`D�'0 EH .s•2a Cvvl