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r , I APPLICATION FOR PERMIT �. SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE. , PHONE (209)468-3420 ! P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FRQM_DATE 155UED il. (Complete in Triplicate) a 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 1$62 and the Rules and Regulations of San Joaquin County Public .Health-Servi es rrqq�q�� Job Address _ PARCEL 253 300 29 BIRD -BOAT? __ City TRACY Lot Size/Acreage it Owner's Name C&A NAVARRA RANCH Address 475 W. BLEWETT TRACY Phone 836-0005 t ;i Contriclor NAOCK PUMP CO. Address 4500FREMONT, STKN I-W License No. 504513 Phone 948-8817 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEIVEENT_0 DESTRUCTION r_1Out of Service well ❑ PUMP INSTALLATION OOX r SYSTEM REPAIR ❑f OTHER ❑ Monitoring Well U DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _DISPOSAL FLO. i PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ' ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing [I Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications I'I Public I:1 Other 171 Delta Depth of Grout Seal Type of Grout �(11(Irri{lation Approx. Depth l I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump TI IRR INF_ H.P, - 1.J)O State Work Done INSTALL PIIMP L BdEW WE Well Destruction 0 Well Diameter Sealing Material & Depth Depth Filler Material & Depth Ib 1` TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION i I DESTRUCTION I I INo septic system permitted it public sewer is available within 200 feet.) Installation will serve: Residence Commercial Other iM 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 kDisposal Distance to nearest: Well Foundation Property Line i� LEACHING LINE ❑ No. & Length of lines Total length/size I FILTER BED Cl—Distance to nearest: Well Foundation Property Line SEEPAGE PITS l I Depth �� Size' Number SUMPS €l Distance to nearest: �W611- Foundation Property Line DISPOSAL PONDS ❑ 19 I hereby certify that I have prepared this application and that the work will be done-.in accordance with San Joaquincounty 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 certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ—person's subject to workman's compensa- tion laws of Calif The applicant m st call all r uired i t• late drawing on reverse side. Signed x D>C LO Title: RETAIL, STALES Date: 6-14-91 FOR DEPARTMENT USE ONLY Application Accepted by Date Area p Pit or Grout Inspection by Date .Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 :u. INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED By DATE i' /]PERMIT NO. + EH 13.24{REV,t i n SI t V C._1�--� 1 Q! (_,] 1 EH�4.2e LLL / (I l tiJ Jr.,