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�Dor.IC�,T*nN SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Tripiicate) 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 add Regulations of Sen Josquin County Public Health Services. Job AddressAlvarez, 25400 South Chrisman Rd City Tracy Lot Site/Acreage 54.82 acres Owner's Name Joe Alvarez Address 8606 W.Schulte Rd. Tracy Phone Contractor FugroGeosciences Address6105 Rookin, Houston, TXLicense NoC57556015 Phone 0 TYPE OF WELL/PUMP- NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ CPT OTHER gi Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ iNTENOED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial ❑ Open Bottom u Manteca Dia. of Well Excavation In Dia. of Well Casing none Dameshci Private ❑ Gravel Pack ❑ Tracy Type of Casmg_none Specifications I'I Public fl Other it Delta Depth of Grout Seal Max 150 ft Type of Grout Neat Cement I rout i litigation _Approx. Depth I I Eastern Surface Seal Installed by FugroGeosciences Repair Work Done U Type of Pump H.P. State Work Done _ Well Destruction ❑ Wall Diameter Sealing Material i Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INO septic sysiem permitted it puolic sewer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number at living units: _ Number of bedrooms Character of and to a depth of 3 fast: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLL❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. i Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Pro PertV Line DISPOSAL PONDS ❑ 1 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 candies the following: "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 workmen's compensation laws of California." Contractor's hiring or subcontracting signature cemfies the following:"I comity that in the performance of the work far which this permit is issued, I shall employ parsons subject to workman's compentd- tion laws of California." The apph"! u all 1 all required inspections. Complete drawing on reverse side. 1 Signed x / � V{ W� title: Hydrogeologist Date: �T��'- �) / , ^ a FOR DEPARTMENT USE ONLY 1 .,��/ 6 i n-I' Lir Application Accepted by Area 'LSC% Date ` 7 Pit or Grout Inspection by u.� Date i Final Inspection by Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services �n I Environmental Health Permit/ServlCe9 "� 445 N San Joaquin, P O Box 2009, Stilts, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED 9y DATE INFO CASH PERMIT NO. Lu°.1..iR(V.i„iyi -,. goo �'.� =- a�[ I � u G Inj): ]2�