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APPLICATION FOR PERMIT • SAN JOAQUIN COUNTY PUBLIC IIEALTH MMENTn ENVIRONMENTAL HEALTH DIV IS 4\`j O 1601 E. HAZELTON AVE. , PHONE (2o P O BOX 2009, STOCKTON, CA �T COUNTY PERMIT EXPIRE ' 1 YEAR FR M9GRVIC C5 (Complete in Tripl OM MENTAL HEAL1ISOM JQ+N BORING DESTRUCTION Application is hereby sled e to San Joaquin County for a permit to construct and/or install the work herein described. This application e 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 26500 Chrisman Road City Tracy Lot Size/Acreage Defense Depot Tracy Address26500 Chrisman Road Phone 209 832-9532 Owner's Name 16/4 Christy Street J.ctor Ensco Environmental_Addre,fremont, CA 94538-3114 LicenseNo.464324 Phone 415 659-0 04 .I TV PE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION sOca of Service Well ❑ V` OTHER!O� Monitoring Well�gf rSOIL BORING PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ ,r` DISTANCE TO NEAREST: SEPTIC TANK +1 On ft SEWER LINES +inn ft DISPOSAL FLO. NA PROP. LINE NA SO I 1N�5 FOUNDATION NA AGRICULTURE WELL NA OTHER WELL NA PITS/SUMPS NI� INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS CH Dia. of Well Casing NONE n Industrial C1 Open Bottom ❑ Manteca Dia. of Well Excavation , Type of Casing-,- asing NONE Specifications Cl Domestic/Private ❑ Gravel Pack ❑ Tracy D - 15 ft Type of Grout Cement BaCk 111 I1 Public (-1 Other I (l Delta Depth of Grout Seal 1 1 Irrigation 1 f5_f,Cpprox. Depth I I Eastern Surface Seat installed by. Repair Work Done ❑ Type of Pump H.P. :State Work Done _ Well Destruction ❑ Well Diameter Sealing Material 6 Depth CPment 0 to 15 feet Depth Filler Material 6 Depth T1: EE OF SEPTIC WORK: NEW INSTALLATION 1 I REPAIR/ADDITION I I DESTRUCTION I I.availseptic systeable shin mpermiNeq - lic sewer is l� Installation will same: Residence_ Commercial_ Other Number of livinglOni - _ Number of bedrooms Ems\ Water table depth v Character of coil to a dept feet: SEPTIC TANK ❑ Type/M g pacity No. Compartments Method of Disposal PKG. TREATMENT PLT. ❑ Distance to nearest: W Foundation Property Line LEACHING LINE ❑ No. g Len lines Total length/size FILTER BED CI Di a to nearest: Well Foundation ro Pert Y Line CP SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line (� DIS SAL PONDS ❑ `V 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, and rules 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 not employ any person in such manner as to become subject to workmen's compensation laws of California." Contractor's hiring or subcontracting 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." - The applicant on st call for all required inspections. Complete drawing on reverse side. Signed 3/15/90 —� � ictrb Title: Hydrolgeologist Date: / F FO AR BE ONLY /„ �Ar Application Accepted by Date Y/ Pit or Grout Inspection by DateFinal Inspection Date Additional Comments: i Applicant - Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Razelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BV DATE PERMIT'NO. NFO CASH . EH 13-24 IREV.I/x51 $35.00 --- ,� b3IS3 11(9 qo�� /. EH 1x le