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= APPLICATION ,WELL M.' 2 OF 3 - SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES t� ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 1 PERMIT EXPIRES 1 YEAR FR if DATE ISSUIM (Complete in Triplicate) Application is hereby made,to San Joaquin County for a Permit to construct and/or install the work herein described. This r application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 8751 E_ E3" 19 ____ City V.i Ct-gZ Lot size/Acreage + 20 Ac. I Owner's Name Dole Fresh Fruit CompanyAddresa Same Phone (209) 334-278 All Terrain Exploration 6330 Brewer Road Contractor Drilling _.Address P1 easant Graves -CA_License No. ��Ls 17R�ti__ Phone — 9 TYPE OF WELL/PUMP: NEW WELL Z1 WELL REPLACEMENT 11 DESTRUCTION 0 Out of Service Wel; Gl PUMP INSTALLATION 0 SYSTEM REPAIR ❑ OTHER C] Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES Nle_----__ - DISPOSAL FLD. NA PROP. LINE 32Rr FOUNDATION NA AGRICULTURE WELL $OOt OTHER WELL 473t PITSISUMPS r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n industrial O Opin Bottom Q Manteca Die, of Well Excavation 1 Dia. of Well Casing 2" ;•D W Domestic/Private ! Gravel Pack 0 Tracy Type of Casing_ PVC Specifications SCH 40 PVC t: I'1 Public ('Z Other f1 Delta Depth o1 Grout Seat 34 Type of Grout Cement I i Irrigation 40 Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump NA H,P. Stats Work Done _ Well Destruction O Well Diameter sealing Material i Depth up Depth Filler Material i Depth a I TYPE OF SEPTIC WORK. NEW INSTALLATION i I REPAIR/ADDITION I 1 DESTRUCTION I I INo septic system permitted it public sewer is J 1 available within 200 fast.) e Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms PA'Y'MENT Character of roil to a depth of 3 feet: —Water" Wicrill SEPTIC TANK C3 Type/Mfg Capacity No. Cp t?r ff 'PKG. TREATMENT PLT. Q Mst JOAQ�JI�IICOUNTY I Distance to nearest: Well Foundation Props r�iCHtALlSERVICES ENVIRONMENTAt HEAttN 131 !ONI 4 LEACHING LINE Cl No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest. Well Founaation - Property Line r; SEEPAGE PITS I I 'Depth Size Number �4 SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 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: "I certify that in the perlormance 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: 1 certify that in the performance of the work for which this permit is issurid, I shall employ persons subject to workman's compsnsa- tion laws of California." `t The applicant t ca or ail required inspections. Complete drawing on reverse side. r Signed Title: Vice President Date: MAY 6 1993 i es C. Saucerm FOR D P TMENT USE ONLY Applicat Accepted byVDale p Area Pit or rout Inspection by Date Final Inspection by - f 1- Additional comments: 'o'-74t/ Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services l� ' 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEEINFO AMOUNT DUE' AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. EH 13-24 IREV.r i w si t l/(/]f) 1 E„ 14-29l/ y r U 11 I