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I'1HH 04 '92 16 Ce CKC INC 9163715621 <br /> APPLICATION <br /> SAM P-2 <br /> QUM COUNTY PUBLICInULTI, <br /> SNVIBpNa(EITAL ALT$ DIVISI U V2CSS <br /> 44-5N <br /> 45N SAN JOA,QUIN, PHONE (209)468-3420 <br /> P O BOX 2009, STOCXTW, C3 9520: <br /> p �I RM)IRRS Y YEAg PROM t1 a Z9 <br /> _j <br /> ss <br /> in Tr "�1`' loau <br /> Al p.licatsoa is hereby aede to iplica�te) <br /> JDDL'aticrs Is made �>Jaa�ee o ��tY for a yermit to cons suet <br /> is c e nd 162 Lad the pony herein described. <br /> °'4usa coutsty Public Health 8<rv'iees. � J"4uia County Ordinance lfo. 549 aaa 1862 aid she Au2es and Regul,atioaa of Snn <br /> Job Address 26700 S. Banta Road <br /> City Tracy Loc Sire/Acree,�e 5. .ctcre� <br /> Ownerm <br /> : NaeALL PURE CHEMICAL C�ANY <br /> Address 11490 W. Linne Road Tra <br /> Coniracttu C-K.C. , Inc. Phone 2�835-5423 <br /> address 852 Nox thport, W. S3C, <br /> TYPE OF WELLIPUMP: LiceNu. 534002 <br /> ,NEW WELL REPLACEMENT (7 '- --P"O^e (916) 37I-5 21 <br /> PUMP INSTALLATION Q `DESTRUCTION Cj 0-:r or Service aelg <br /> Ol5TANCE TO NEAREST: S SYSTEM AEPAIR <br /> EPTIC TANKC�01 SEWER LINES 9 r SQ' OTHEAx i ng p� <br /> FOUNDATION�r 10' DISPOSAL FLO, 150' PROP. t.lN f f <br /> ---- AGRICULTURE WELL 100, OTHER WELL ZOO' <br /> INTENDED USE TYPE OF WELL PROBLEM AREA PETS/SUMPS 1_5(),C7 Industrial 0 Open Bottom CONSTRUCTION SPECIFICATIONS <br /> n Oamestic/private O ^—T Dia, of WaH Excavation <br /> Gravel Peekn <br /> I'I Pub(io � OtMr 0 Tracy Type of Caning PVC Dia. at Well Casing 2 <br /> I5' n Delta Depth of Grout Seal h Sorcificatiatu :VT <br /> t 1 iniQatlOn GroutC@tT1e21� <br /> Approx. Depth I t Eastern surface soul Instaltad by Tri <br /> Repair Work D� U Type of Pump Nr <br /> Wall Destruction 0 m 11 <br /> We4 Dieetat _ H.P. State Work Dont <br /> Ses.11tta at:td rlal i Depth <br /> Depth ����, 7Yllar )kr-eni.sl i OepLi: <br /> TYP£ OF SEPTIC WORK: NEW INSTALLATION I 1 <br /> AEPAIR/ADDITION 1 I OESTAUCTION I I Wo septic systam�— <br /> lnstallation win sent': R denca within oarmiand if public sower ice <br /> Comrnerttia!�. Other available <br /> Z00 foot.) <br /> Numb"of living Unita: Number of bedroama <br /> Charsctlr of UW to a depth of 3 fact: ,I <br /> SEPTIC TANK. C3 Type/Mfg Wat" table depth r <br /> PKG. TREATMENT PLT, 0 Capacity__.___ No. C*M0 tments C <br /> Distance to nearest: Method of olsposal C <br /> W�-----,._, Foundation Property Lire <br /> LEACHING LINE 0 No. 6 Length of linea <br /> FILTER BED O Distance to Total iengtn%siza <br /> west: Wolf Foundation <br /> Property Lute <br /> SEEPAGE Pt'$ I I Death —�" <br /> SUMPS ave Number <br /> • Lt Distance to nearear. yy@y <br /> DISPOSAL PONOS Q Foundation prop rty Line <br /> I hereby term" "tat ian 1 neve prepared this 30,01uaty t ar�C that the wdtk will be done in accondancs with San JO <br /> fuias and l'eguiations of the San Joaquin County <br /> Home owner or Win county ordinances, state laws, and <br /> Gn In such <br /> agent s si9naturs txrtiftea the loflowing: q t:ardly that in the <br /> employ any Draon(n such manner as to became subject to workman's cos performance of the work for which this <br /> porn,t is issudd,auormi we f o NI tasrrlfY that in the p"lormance o!the work for which a tion laws o!CaGfomia:"'Cbntrsctoe,hiring or s b_Contracting islgnatha not <br /> W+n+it is issued, I ahall employ persons saJbiect ro workman's campensa• <br /> ufe <br /> The ap�t cad foc sU required inspections. Com <br /> �—: plate drawing on repent side. <br /> rtle: �•GE'IERAL MANAGER Ogre: 2/28/92 <br /> app�Hort FOR iDEPARTAIENT USE ONLY <br /> Dace - � <br /> P4or Grout 1specLort by irk `-J I Jc ? Area <br /> F <br /> Add wl Inspection by <br /> nlanal Colt+menta Date <br /> aoolieanL — <br /> Return all cooles to: San Joaquin County Public Health Services <br /> Environmental }lealtrt <br /> 445 'J San Permit/ServicesFEE / <br /> oaqu2a, p 0 fox 2009, St:kn, CA 99201q <br /> INFO JAMOUNT OVE AMOUNT REMtTTEt) J <br /> CASH AFCtIVED !Y DATE <br /> 1 14-:.trtEv.I..st OC ` .� o P"MIT 110 <br /> . <br />