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a^ • APPLICATION FOR PERMIT• <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> (209) 468-3447 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application Is hereby made.to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in coatpliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. <br /> Job Address L NL Site 300 Corral Follow Road CityS• of Tracy Lot Size/Acreage <br /> owner's Name U.S. Dept. of Energy Address1333 Broadway, Oakland, CA 94612Phone (510) 273-711 <br /> 1780 Vernon St. (916) <br /> Contractor PC Exploration Address Roseville, CA 95678 License No. 265556 Phone 783-9733 <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER $) Monitorin Well <br /> Monitor wells atfa <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES — DISPOSAL FLD. PROP. LINE exp1oratory <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ borehc les <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> M Industrial O Open Bottom O Manteca Dia. of Well Excavation 101, Dia. of Well Casing 4 <br /> n <br /> U Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing POC Specifications ite <br /> M Public CI Other O Delta Depth of Grout Seal a Type of Grout <br /> CI Irrigation Approx. Depth G Eastern Surface Saul Installed PC Oration <br /> Repair Work Done U Type of Pump H.P. St to Work Don _ <br /> Well Destruction O Well Diameter Sealing Material i Dept <br /> Depth Filler i Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 0 R AIR/ ITION CI DE RUCTI CI o septic ysiem permitted it public sewer is <br /> a ailable thin 200 feet.) <br /> Installation will serve: Residence_ Commercial_ Ot er <br /> Number of living units: Nu ber of bedrooms <br /> Character of soil to a depth of 3 feet: XCompants <br /> SEPTIC TANK O Type/Mfg Capacity PKG. TREATMENT PLT. Cl Distance to neares Well F undation Prop <br /> . fl <br /> LEACHING LINE C1 No. & Length of lines otal le h/size '" <br /> Jj <br /> FILTER BED C) Distance to nearest: ell Foundah Property L4% t 0 8 1 92 <br /> � r <br /> SEEPAGE PITS 11 Depth Size Number PUBLIC HEALTH �FLRVIt roj <br /> SUMPS LI Distance to nearest: Well Foundation PrUPC <br /> XV ENTAL NL.+.i i ' DIVISION <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that 1 have prepared this application and that the w rk ill be one in cc it an Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin County <br /> Home owner or licensed agent's signature Certifies the following: "I cenif hat in the r n he work for which this permit is issued, I shall not <br /> employ any person in such manner as to become subject to workman's ompensation Is 0 Ii 'a " Contractor's hiring or subcontracting signature <br /> certifies the following; "I Certify that in the performance of the work f which this permit esu I I employ persons subject to workman's compensa <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete awing on reverse side. <br /> Signed �Gliv►.An/tr` Title: Section Lea Date: 2/19/92 <br /> FOR DEPARTMENT USE ONLY �J <br /> Application Accepted by Date �Q��D"9 l.� Area <br /> Pit or Grout Inspection by Date Final Inspection by Date <br /> Additional Comments: _ <br /> Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES /I ��•l <br /> 445 N SAN JOAQUIN, P 0 BOX 2009, STOCKTON, CA 95201 " lJ <br /> FEE <br /> INFO AMOUNT DUE AMOUNT REMITTED K R CEIVED BY DATE PERMIT N0. <br /> . EN 13-21111EV.i/xSI 69m 9)9,(Z -6/ca ,9� <br /> FH 114-26 <br />