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APPLICATION SAN &QUIN COUNTY PUBLIC HEALTH,*VICES ENVIRONMENTAL HEALTH DIVISt _.V 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 _PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to conatruct and/or install the vork herein described. This 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 500 EAST LOU I SE /AVENUE City LATHROP Lot Size/Acreage 177.6 ACRES Owner's Name L I BBEY MENS FORD (OMPANYAddress 500 EAST LOU I SE AVENUEphone 209/95 i-5151 Contractor SPECTRUM EXPLORATION Address 2825 EAST MYRTLE STREET License No. 512268 Phone 209/465-871 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Ll DESTRUCTION ❑ Out of Service well :1PUMP INSTALLATION ❑ SYSTEM REPAIR C1BOR'1%G OTHER Cd Monitoring Well OtSTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE _ FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom (X Manteca Dia. of Well Excavation S Dia. of Well Casing 4 1 NCHES C.1 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing PVC SpecificationsUE WORK PLAN I'1 Public M Other fl Delta Depth of Grout Seal 5 FEET Type of GrouLEAT CPT'E VB IT I I Irrigation 20'Approx. Depth I I Eastern Surface Seal Installed by SPECTRUM EXPLORATION Repair Work Done ❑ Type of Pump N/A H.P. N/A State Work Don$ 1. Well Destruction ❑ Well Diameter 4" Sealing Material A Depth BENTON I TE .S TO Depth 2or Filler Material i Depth N/A C TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is �. / available within 200 feet.) Installer on will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line c LEACHING LINE ❑ No. 6 Length of lines Total length/size FILTERBEp ❑ Distance to nearest: Well Foundation Property Line N/A SEEPAGE PITS 11 Depth Size Number SUMPS N/A LI Distance to nearest: Well Foundation Property Lina DISPOSAL PONDS ❑ 1 hereby certify that I he" 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 Homo owner r licensed agent's signaturecoecertifies subject following: "I certify penin the performance of the y1aLk for 'ch this.-ria 'Irpy isjyusd,91 shall not employ any person in such manner as to become Aub ct to workmen's compensation Laws of California.' ri,`'f,,U?a�.yjarb^1llf`L'arll�/lu{actin signature certifies the following:"I certify that in the performance of the work for which this permit is issued, I shall ploy rSon o man's compenaa tion laws of California." The applicant mu _call to I requir Inspections. Complete drawing on reverse side. Signed !-7 Title: ACTING ENVIRONMENTAL Date: 6/9/92 RDINATOR FOR DEPARTMENT USE ONLY �/ Application Accepted by Date - !f/ Area Pit or Grout Inspection by Date Final Inspection by Dat Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services �1' 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 `i 6 FEE INFO AMOUNT DUE AMOUNT REMITTED R EIVED BY DATE PERMITNO. 99 j}'��y�\ J/��9 �j� /fin(j /J� /yy'�/ . H113.2a IREV.Ir�ar S /•.-�+ V/i�`i 1!/L7� � ��7(� 4341- EH U.2a