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APPLICATION f WELL M-' -OF 3 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION • 445 N SAN JOAQUIN, PHONES (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUM (Complete in Triplicate) f Ayplication In hereby made,to San Joaquin County for a permit to construct and/or install the vork herein described. This application is made in compliance vlth San Joaquin County Ordinance No. 549 and 1862 and.the Rules and Regulations of San Joaquin County Public Health Services., Job Address 8751 E. Hwy 12 City Victor Lot size/Acreage + 20 Ac, Owner's Name Dole Fresh Fruit Company Address Same phone 209 334-2780 a All Terrain Exploration 6330 Brewer Road 3/31/95 Contractor =' ?riatiAddress P1 e L-app-�ratrp, C'A - _License No.�r�Phone - 049 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service well C❑ r PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitor ing Well :VDISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA DISPOSAL FLD. A PROP. LINE 1-0f- FOUNDATION � — AGRICULTURE WELL — OTHER WELL Z94 PITS/SUMPSI5 INTENDED_USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS _ - rr Ll Industrial C3 Open Bottom 0 Manteca Dia. of Well Excavation i Dia. of Weil Casing { [iDomestic/Private C�Gravel Pack ❑ Tracy Type of Casing PVC Specifications SC H- /AQ PVC— Il Public 1-1 Other Cl Delta Depth of Grout Seal 34f _ Type of Grout Cement I I Irrigation 40tApprox. Depth I I Eastern. Surface Seal installed by TP,�OM TECH Repair Work Done U Type of Pump NA r H.P. • State Work Done Well Destruction ElWell Diameter Sealing Material"i Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I l.lNo septic system permitted if public sewer is available within 200 lost.) Installation will serve: Residence— Commercial— Other Number of living units: Number of bedrooms Character of sad to a depth of 3 feat: Water table depth . SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ , Motif Ar atstfae�— w..: I Distance to nearest: Well Foundation Property Li i LEACHING LINE ❑ No. A Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Props 5R�`�0 NTY SEEPAGE PITS 11 Depth Size Number WE n �V1510 SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hsrsby certify that I have prepared this application and that the work will be done in accardance with San Joaquin county ordinances, state laws. and rules and regulations of the San Joaquin County Hama owner or licensed agent's signature certifies the Ioliowing: "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 sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued. I shall employ parsons subject to workman's compensa- tion laws of California." The apprcepted r all required inspections. Complete drawing on reverse side. Sigma Title: _ Vi r•P PrPgiclenit Date: . Sauce O DEPARTMENT USE ONLY ApplicatDate � Area Pit or Gy Date inal Inspection by �' '`� Date 1l "If Addition1 Applicant - Return all copies to: San Joaquin ounty Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED N K RECEIVED 8Y DATE PERMIT"N0. INFO y Q pp . EM 13.24 IREV.r R5,5, � 1H t4-Z4 l