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MAR 04 '92 16:30 CKC INC 9163715821 APPLICATION P.2 - SAN *QUIN COUNTY PUBLIC HFEtLTH AVICES ENVIRONMENTAL R7AT.TH DIVISION 445 N SAN JOAQUIN, PHONE (209)468--3420 P 0 BOX 2009, STOCXTON, CA 95201 PERMIT RIPiRRS I YEAR FROM DATE, ISSMM- (Comple•te in Triplicate) App1-1cA%'1= is hereby made.to San Joaquin Cottaty far a permit to construct and/or instill the vorY herein described. Tht.s appl::atioa is made in cocpllancc with Ban Joaquin County Ordinance No. 549 and 1862 Lad the Rules and Regulations or San Joaquin County Public Health Services. Job Address 26700 S. Banta Road City 'icy Lot 3ise/Aaresge S•3.ucres O,,,ner'. N,maAIL FORE CHEMICAL CCHPANY Address 11490 W. Linne Road, Tracy _ phone 209 835-5423 Centr3yor C.K.C. r Inc. Address852 Northport, W. Sac. License No. 534002 phone (916) 371-5J21 TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT n " 'DESTRUCTION IJ CA:r yr Service+ ae.0 ❑ PUMP INSTALLATION O SYSTEM REPAIR C) OTHER i n8 We.0 + over 50' over 50' 150' PR �-�fI DISTANCE T4 NEAREST: SEPTIC TANK ScWER LINES DISPOSAL FLO. PROP. L1N FOUNDATION over 10' AGRICULTURE WELL 100 OTHER WELL 100' PITS/SUMPS 150 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Q Industrial 0 Open 8otttun ❑ Manteca Dia, of Wail Excavation Dia. of Wou Casing 2" n Damastie/private ❑ Gravel Pack 0 Tracy Type of Casing PVC Specificatiarhs 2= [I Publk M Omer n Delta Depth of Grout Seal ' _ 4) T„oa o} Grou cement 11460260A 1511 Approx. Depth I I Esstom Surface Soul Install4d by Treif fLt Aepair Wort Oahe ❑ Tyne of Pump NA H.P. Stats Work Dont= MA Weu D'W=ction O WNI Diameter ATA Seallt:a %Ltarial i Depth Depth NA 7112er xaterial i Depth NA TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/AOOiT10N I I DESTRUCTION I I (No septic system pormittad if Public sawee is 1� available within 200 feet.) Irutauatian wi4 serve: Rasidenra_ Commercial_ Othar �I Number of living units Number of bodrooma T Character of spit to s depth of 3 feet: Water t,bla depth C SEPTIC TANK. O Typo/Mfg Capacity No. Compartments C PKG. TREATMENT PLT. 0 Method of Disposal Distance to nearest: Weft Foundation Property Line ' L LEACHING LINE 0 No_ 3 Length of lines Total iengthisiza FILTER BED C Distance to nearest: Walt Foundation Property Lute SEEPAGE PITS I I Depth Size Number SUMPS Ll Oistanca to nearesr. We* Foundation Property Line DISPOSAL PONDS O I haraby certiiy Mat I have prepared this application and Ehst the work will be done in sccotdancs with San Joscluin county ordinances, state laws, and rules and regulations of the San Joaduin County Home owner at licansed agent's signature certifies the following: "I enmity that in the periormance at the work for which this permit is issued, 1 shall riot employ any person In such manner as to becarne subiaes to workman's compensation laws of Cafifortua.—Cbntrsctofs hiring or sub-contracting signature certifies the fotbwing:"I cwtlfy slut in me padormancs of the worst far which this permit is issued. I shall omplay Persons subject to workman's componsa- tion taws of California." The ,ppiicsm c W los ad required inspections. Complete drawing on reverses side. Signed X !� .�?r T;t1e' ':GENERAL :MANAGER Data: 2/28/92 FOR DEPARTMENT USE ONLY patio,, ey 7 1 ✓ Date J� I C/y Al" If Plc or Grout Irfrpaebon by "�i� GL,= Dars�– Final Inspection by �� Data Additional Coirinwets: Apolicant – Roturn all copies to: Sas Joaquin County Public Health Services Bnvirottmentsl Health Permit/services l(. 445 S Ian Joaquin, P 0 Sox 2000, Stkn, CA 95202 FEEf� AA40UNT OtJE AMGUNT RfiMITTEO CASH AECIIVE0 By CAT`E PERMa"Nis. CA 3-:4 IAEV.I/A3)