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� II I� APPLICATION FOR PERMIT( ) t I SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES I! ENVIRONMENTAL HEALTH DIVISION F l P O Bog 2009, STOCKTON, CA 95201 KA Jog i , A209) 468-3447 20-3474-01 PERMIT AIRES 1 YEAR IRON 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 cozWliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Ban Joaquin County Public Health Services. APN 177-100-20 & 28 + 2.1 AGRI—INDUSTRIAL PARK 2771 E. French Camp Road City Manteca Lot Site/Acreage Job Address CA 95336 lI Owner's Name Ace Tomato Address 2771 E. "French Camp Rd. Manteca Phone Contractor S ectrum/Kleinfelder Address 2825 E. Myrtle Street License No. 512�� Ph-pne 948-1345 f TYPE OF WELLIPUMP: �� NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION PUMP INSTALLATION C) SYSTEM REPAIR ❑mi OTHER M C� DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PR(jP-tffdf 9 Test Bor ngs r- r De P IF FOUNDATION AGRICULTURE WELL OTHER WELL W�$ESk}A4i� 15 Dia. INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS fl Industrial ❑ Open Bottom ❑ Manteca Dia, of Well Excavation -0+aref-1Alell-Casing No GW anticipated. U Domestic I Private ❑ Gravel Pack ❑ Tracy Type of Casing 6fleerf at�oas If GW 1 L Public f-1 Other ❑ Delta Depth of Grout Seal i '��rt 4 encountered,will 1 i 0 Irrigation �I�,Approx. Depth ❑ Eastern Surface Seal Installed by J H.P. State Work Done _ backfill with Repair Work Done ❑ Type of Pump Sealing Material L Depth Hale Plug Well Destruction ❑ Well Diameter " r Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIR/ADDITION 0 DESTRUCTION CI INo septic system permitted if public sewer is II available within 200 feet.} o Installation will serve: Residence— Commercial____ Other E D 1 Number of living units: li Number of bed G Character of soil to a depth"'f 3 feet: PWater table depth SEPTIC TANK ❑ Type/Mfg C i d Wfir No, Compartments PKG. TREATMENT PLT, G1 ,l UAIJMethod of Disposal ii WarmPlaut-0 ''QQ}} OI' If1S P,G}p Distance to nearest: Lpgo� 1 Ry Line F T r i . HRa LEACHING LINE Cl No. 8 Length of lines Total length/size (21 FILTER BED Cf Distance to nearest: Well Foundation Property Line .I� SEEPAGE PITS l I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ s I hereby canify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, slate laws, anc rules and regulations of the San Joaquin County _ V 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 mariner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify Shat in the performance of the work for which this permit is issued, I shall employ persons subiect to workman's compensa- tion laws of California." The applicant 1 call for all ired inspections. Complete drawing on reverse side. Engineering ineerin Geologist 4-4-91 Signed Title: Date: li FO DEPARTfMENT USE ONLY / �} ! Application Accepted by I Date L Area cam/ ji: Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ' , - il Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ,ry ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 9II 445 N SAN JOAQUIN, P 0 BOX 2009, STOCKTON, CA 85201 FEE AMOUNT DUE AMOUNT REMCTTED CK RECEIVED BY DATE PERMIT'NO. IN(F./(O� CASHEN 13-24 01 1/015 1 q I EH?1.26 L