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APPLICATION FOR PERMIT *• i t SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P O BOX 2009, STOCKTON, CA 95201 (249) 468-3447 R PROM DATE I SBUED (Complete in Triplicate) Application is hereby made to Saa Joaquin County for a permit to construct end/or install the work herein described. This application Is made In cONFII .nce with San Joaquin County Ordinance No. 549 and 1862 am the Rules and Regulations of San Joaquin County Public Health Services. Job Address 244' North and 953' West from Southeast City Tracy Got Size/Acreage 53.41 Acres corner of Section 9, T 2S, R 5E, MDB&M owner•, Name Tri-Valley Oil & Gas Address 3240 Marshall Ave. , Carmichael Phone 916-482-2847 Cbmiactor Paul Graham DrillingAddress P•O•Box 669, Rio Vista Li298002 707-374-51 3 License No, Phone L+ TYPE OFYWE-LL/PUMP: r -,- ANEW WE-L.L,0_; ;� WELL REPLACEMENT Cl '--._.D.ESTRUCTiONt0 Out of,Servlce Well 0 PUMP INSTALLATION pMonitors SYSTEM REPAIR ❑ Gas Well OTHER KI � Well DISTANCE TO NEAREST: SEPTIC TANK 4 mule SEWER LINES 4 m110 DISPOSAL FLD. 4 11"lePROP. LINE 2001 FOUNDATION AGRICULTURE WELL 0 OTHER WELL PITS/SUMPST-Mile 500 t INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ` Cl industrial C Open Bottom 0 Manteca Dia. of Well Excavation Dia. of Well Casing U Domestic/Private ❑ Gravel Pack L3 Tracy Type of Casing Specifications - 0 Public Xl Other 0 Delta Depth of Grout Seal --- Type of Grout Irnuauon 12000' Appsox. Depth ❑ Eastern Surface Soul Installed by I Repair Work Done U Type of Pump H.P, State Work Done _ Well Destruction 0 Well Diameter 9-7Z811 Sealing Material L Depth Depth Filler Material 4 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIR/ADDITION 27 DESTRUCTION M (No septic system permitted if public sewer is � available within 200 feet.) Installation will serve: Residence a Commercial — Other +II Number of living units: Number of bedrooms Character of soil to a depth of 3 fest: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 6 Length of lines Total length/size FILTER $ED Cl Distance to nearest: Well Foundation Property Line S_EEPAGE tITS: � I_I Depth- - Sire. _ _ Number-. SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state fuses and regulations Of the San Joaquin County Taws, and 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 a-Ploy any person in such manner as to become subtecl fo workman's compensation laws of California.- Contractor's hiring or sub-contracting signarule caMifies the following: "I certify that in the performance of the work for which this permit 14 issued, I shelf employ persons subject to workman's compensa tion laws of Cahlofnls." The applicant must Gall for all required inspections a ra Ing on reverse side. _ Title: Petroleum Engineer Date: 12/2/97 Irani � FOR DEPARTMENT USE ONLY Application Accepted by Date Area Pit or Grout lnspecticn by Date Final Inspection by Date Addat onsl Comments: Applicant - Return ell copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONLENTAL HEALTH DIVISION PE"IT/SERVICES 445 N SAN JOAQUIN, P 0 BOX 2009, STOCKTON, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CK INFO CASH RECEIVED BY DATE PERMIT NO. fn 137k iRfV .,�Ot fn '4 ay 1