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APPLICtTTON SAN JUIN COUNTY PUBLIC HEALTH SERRVICES 7 ENVIRONMENTAL HEALTH DIVISIONJ � " ,f li 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 MAY 1 2 1993 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) ENVIRONMENTAL HEALTH PERMIT/SERVICES Application 1s hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in complia Ce with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health .e?cl,ee. Job Address DDRW-Tracy, So. Chrisman Rd city Tracy Lot size/Acreage 448-acre DDRW- Sharpe, Roth Rd, Marshall Cloud Owners Name Defense Logistics AgencyAdd,,,, Lathrop, CA 95330 Phone 2091982-2086 Contractor Gregg Drilling Address42 Berry Dr, Pacheco, CA License No.C57485165 Phones -444 TYPE OF WELL/PUMP NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ g42.SoilOTHER ® Monitorl Well Lq orings 24 wel s DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bortom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 4" CI Domestic/Private IR Gravel Pack IR Tracy Type of Casing-SCh 40 pvc Specifications Soh 40 I'I Public I31 Othwborings fl Delta Depth o(Grout Seal 20' ave. Type of Grout Po 1 and TT I litigation InApprox. Depth I I Eastern Surface Seal Installed by Contractor, See above cement Repair Work Done U Type of Pump NA H.P. State Work Done_ Well Destruction ❑ Well Diameter NA Sealing Material a Depth Depth Piller Material E Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No saplic system permitted in public www is available within 200 laa.l Installation will verve: Residence_ Commercial_ Other Number of living unite _ Number of bedrooms Character of Wil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capscity No, Compartments III TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Wel Foundation Property Lear LEACHING LINE ❑ No. It Length of linea Total length/size FILTER BED ❑ Distance to nesi Wed Foundation Property Line SEEPAGE PITS I I Depth Sire Number SUMPS LI Distance to neereat: Wal Foundation Property Line DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this application and that the work will be done in accordenc i with San Joaquin county ordinances, slab laws, and rules and regulations of the San Joaquin coupty Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this perms is issued, I shelf not employ any person in with manner u to become subject to workman's compensation laws of Celforke." Cottrecti hiring or sub-contracting signature certifies the following: "I certify that in the Wonmence of the wok for which this permit is i sued, I shall employ persons subject to workman's companea tion laws of California." The applicant must cal for el requilr n Complete drawing on reverse side. Signed x_ 1 � Tide: Proiect Manaizer Date; 5/10/93 _ �y,� FOR DEPARTMENT USE ONLY Application Accepted by / r IrC°�—till: Dab Area / Ph or Grout Inspect ion tri - Data /0 Final Inspection b1i • Date 7 23 Addidbnal Common Applicant - Return all copies to: San Joaquin County Public Health Services Envireseental Health Perslt/Services J 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE INFO AMOUNT ,MOUNT/vD]It1E AMOUN/!yT1�R�EMITTED CA9N R�ECE,IVE�D/ay DATE PERM91T N0. =N 11741aev.irael T! /' '•,.a1 r