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• APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PAVjW ENVIRONMENTAL HEALTH DIVISION R�. ,►/ Nr 1 E. HAZELTON AVE. , PHONE (209)468-3420 CEI'/ � OO 1V/ P 0 BOR 2009, STOCKTON, CA 95201 illy \vC PERMIT EXPIRES 1 YEAR FROM DATE Issv�d'UHN�; Q tit C( (Complete in Triplicate) VIRONMEN7A THcERVICES Application is hereby made to San Joaquin County for a permit to construct and/or Install the work herein de cHrRYP10Nhis 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 26500 Chri sman Road city Tracy Lot Size/Acreage Owner's Name Defense Depot Tracy Address 26500 Chri sman Road Phone 209 832-9532 Contractor Water Development CorAdress 220 N. East Street License No.283-326 Phon4916 662-28 9 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER 91 Monitoring Well xT DISTANCE TO NEAREST: SEPTIC TANK 100 ft SEWER LINES 'H 100 ft DISPOSAL FLD. PROP. LINE NA FOUNDATION AGRICULTURE WELL +60f tOTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS D Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation I-0---i-n-clieS Dia. of Well Casing ^ [I Domestic/Private X1 Gravel Pack X, Tracy Type of CasingSChedUl a 80 PVC ri V 'Specifications SPP atta Che I'I Public ❑ Other fl Delta Depth of Grout Seal See Attached Type of GroutSee Attached f p I I litigation _Approx. Depth I I Eastern Surface Seal Installed by A Repair Work Done ❑ Type of Pump None H.P. Ste �(ori{ q Well Destruction ❑ Well Diameter 4-inch Sealing Material 6 Depth �ET VfAt Depth Filler Material 6 Depth SEE ATTACHED TYPPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION 11 (No septic system permitted it public sewer is available within 200 feet.I Installation will some: nce_ Commercial_ Other Number of living units: _ Nu of bedrooms Character of soil to a depth of 3 feet: er table depth \\ SEPTIC TANK ❑ Type/Mfg Capacit No. Compartments (\l PKG. TREATMENT PLT. ❑ Method of Disposal YI Distance to nearest: Well Foundab Property Line r1S LEACHING LINE ❑ No. 6 Lenlines Total len its FILTER BED CI ce to nearest: Well Foundation Property SEEPAGE PIT 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DIS OSAL PONDS ❑ 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 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." The applicant must call for 911 required inspections. Complete drawing on reverse side. Signed x 4.Gw04_ Q• �� /t. b Title: HYf1RO�GF01 OGTST Date: April 15, 1990 EP LHJT USE ONLY r C Application Accepted Date �y �C ' rea ��11 Pit or Grout Inspection Date O Final Inspection by Datta Additional Comments: Applicant — Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE INFO AMOUNT DUE AMOUNT EnEMITTED CASH RECEIVED BY DATE PERMR'N0. • EEH 3H 1,24 24IREV.1/x51 $35.00* 3 3 53 � 4i7 O-/y Z- / J * ADDITIONAL 35.00 PER HOUR IdILL RE RILI_FD FOR ExrRA 1/TS1TC nFrFR FTpCT /J/