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� 10RESNR , SACRAME�LTO-, - 7'EE : 916-852-6688 Dec 15 '92 1647 No .007 P .02 APPLICATION FOR PERMIT SAN .IOARUIN COUNTY PUBLIC uALTH SERVICES " I ENVIRON1LENTAL nEALTB DIVISION 445 N SAN JOARUIN, PHONE (209)488-8420 j P 0 80$ 2009, STOCKTON, CA 95201 vt;zzi(YT Mfg a I YEAR yFROM DAVE_18. F8C3F (Compiete ,in Triplicame Application is hereby =do.%* asst Joaquin County for a per!at.to Cbttatrao: Andior LnxrAu the vorlt herein described. '£hie application is msde is corapliApee vith Sas woaquln County Ordinance No. 549 and 1862 and the Rales sad Ro$uletiane of San 3o*4uia Catulty Public Healta Services. Covet Ricc,ht of Wayy alozlg Patterson Pass Rd. „pt Size/Acreage 5,900 s ___C .__ 1aa Address rimer5775 5c�. P' ttersan PixSs Fa „–� __ City_ Ti act. ._- _ r ARCO Products Ca. AdoteB: 2000 Alameda de los Pulgess vo(aPh na0x(415) 571-246 Owner's Name Cj b , [��c� c�.. 510 Gtsnitactor _ �L�, 1 Adatess __ ... + ;cense No. fC3�..--Pnone 4 TYPE OF WELL,/PUMP: NEW WELL WELL REPLACEMENT :, DESTRUCTION ci 4�t of SarYice hell { SYSTEM REPAIR in OTHER monitoring Well ❑ —�� PUMP INSTALLATION DISTANCE TO NEAREST: SEPTIC TANK . SA SEWER LINES >tQQ ft- -_ DISPOSAL FLD. PR� :IA FOUNDATION . -- AGRICULTURE WELL .��-- OTHER WELL_... -r— PITWSUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 1 Industries 0 Open Bottom ❑ Mont ooa bis. of Well:Excavation Dia. of Well Caning d I-1 RofnetliC/Private Growl �ft & X Tracy TyDo of Casing– 141 M Specilieation$ it Public t'l Other 80-�100 n pelta Depth of (trout Seat .r40 ft_ Type of Grout I I Irrigation Approll `Depth t I Eastern Surface Soul Installed b. Repan Work Dona 0Type of PumpH.P. State Work Done_ Wap Destruction 0 Well ola nalsr. SeaLit� Material i ilspth Depth I- Tiller Xsterial a Depth TYPE Of SEPTIC WORK: NEW INSTALLATION I i AEPAIRIAIDDITION.l 1 OESTALIVION l I iNo ivaitaws SeptiM1 yet m permtreated if puolic sewer is Installation will reeve: .Aosidsnw L 1 Commercial_. Other Number of *tfirto units; — Nunntiei of bedroom$ „ Chsrrecteof soN to a oath of 9 hot;t Warr table depth SEPTIC TANK. O Type/Mfg' Capacity No. Cor"All"w4nts PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation= P.roloorty Line . 1 LEACHING LINE 0 No. 3 Length of lines Total ttngthlailte FILTER BED0 Dieunce#io nearest: Weil Foundation" Property Line ,. SEEPAGE PITS I 1 Depth t Si;e Number SUMP$ LI pittanea ep nyreat: WellP Foundation _. Property Line DISPOSAL PONOS 0 . }I - t I hereby ConitV.1hii I have prepared this application and that the work will be done in Accordance with San Joaquin COuAIy otdinanCet, state lswt, and rules and regulations of the San .loegtiin County H M owner or lie*nW epant't Wnetuie oertilies the following: "t oertily that in the performance of the work for which this peenttt it issued, 1 shell not dmoloy any person in such rMnMr a$to beeorns subioct to workman's comDens000n laws of California." Contractor's hiring or subcontracting sipnotur —� certlfiee ft fallowing:"I cortlfy Chet in the peftermsnca of the work for wAioh:flit permit%iteued. I shall ampl0y persona r4btact to workman'$COmpanta• tion Uwe of CiAlwnw." l The appNceni tell cart f r all1sq - ed insar�atfone. Complete arevrfng on reverse fids.r i Sigretid X ZV A •YJ Title: "� /' past I>el . t FOR D1rPARTMETYT USE ONLY Ill ` Lt Application Aoeepted by Ree f t4 Area Pit or Grout Inspe�alwin by ( Date Final Inspection by Det* Additional Comments: IY- spptiCant Return �fl1321LOiQu pu lie its; teaithRaviroatentrh� Permit/tlerViaea � �� 7� 145 N 340 Joaquin, P 0 Ants 9008, 9tRn, CA 96201 FEE AMQVNT;7t1E _ AMOUNT REMST7 0 GaS RECEIVED BY OATE PERMIT'No. INFO air ta.ar 1.