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11 ` RETURN PERMIT + A APPLICATION FOR PERMIT RANEY GEOTECHNICAL SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Attn: Joe Brusca }APN 179- 80-14 ENVIRONMENTAL HEALTH DIVISION 3176 Industrial Blvd. IRANEY JOB NO. 427-028 1601 E. HAZELTON AVE. , PHONE (209)468-3=420 West Sacramento, CA 9569: II P 0 BOX 2009, STOCKTON, CA 95201 (916) 371-0434 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I (Complete in Triplicate) I6. Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This 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-Transworld _Dr', East of Quan_tas_L -W _ _ . CitySSt-�ektnn Lot sire/Acreage 9-96 acY25 !� 8372 Carbide Court Owner's Nime Massie and Company Address Sacramento, CA� 95828 Phone (916)689»8120 li 3663 Omec Circle, Suite 8 Contractor B&F Drilling, Inc. AddressRancho Cordova, CA 9574Zicense No. 519428 Phone(916)631-954 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT O DESTRUCTION 0 Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR 0 OTHER ❑ Monitoring Well ❑ M DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER LINES N/A DISPOSAL FLD. N/A PROP. LINE N/A i� FOUNDATION N/A AGRICULTURE WELL N/A OTHER WELL N/A PITS/SUMPSN A u INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing h Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications I"I Public f-1 Other n Delta Depth of Grout Seal Type of Grout i h# Irrigation __ .Approx. Depth 1 1 Eastern Surface Seal Installed by Repair Work Done ❑ T pe of Pump H.P. State Work Done_ G� ? +�toA+L ❑ B=meter 411 + Sealing Material & Depth Cement or Bentonite gout pthVaries 100 t0 15'Filler Material & Depth If groundwater encountered STYPE OF SEPTIC WORK: NEW INSTALLATION f I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is 'I available within 200 feet.) 0 Installation will serve: Residence_ Commercial T Other ii Number of living units: Number of bedrooms Character of soil to a depth of 3 feet, Water table depth SEPTIC TANK. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line H SEEPAGE PITS I I Depth Size Number 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, andD. krules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall note, femploy 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 persons subject to workman's compensa- tion laws of California." �f h Theapplica mus all for all required inspections. Complete drawing on reverse side. signed K Title: Staff Geologist Dace: 8/2/90 r" II Flo R��z T�ettrt ECAC FOR DEPARTMENT USE ONLY pplicstion Accepted by Date—_V_r �G 6 Area It Pit or Grout Inspection by Date Final Inspection by�, } _ Date �D N Additional Comments: k Applicant - Return all copies to: San Joaquin County Public Health ii Services, Environmental Health Permit/Services I 1601 E. Hazelton Ave., P 2009, Stockton, CA 95201 FEE it INFO AMOUNT DUE AMOUNT REMITTED ASH RECEIVED BY DATE PERMIT N0. N . EH 13•Y4 INEV.1/x51 "� "l EH 2 .26 0�y CJ— /, 0 r 4{J `7'_q�} // r ` Li