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APPLICATION S WELL 'PP�alOF ` a✓ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 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 glade to San Joaquin County for a permit to construct end/or install the work herein described. This application is made in coetpliance vith San Joaquin County Ordinance No. 549 and 1862 and.tbe Rules and Regulations of San Joaquin County Public Health Servicea., Job Address 8751 E. Hwy 12 City Victor Lot Size/Acreage + 20 Ac, Owners Name Dole Fresh Fruit Company Address Same Phone (209) 334-2780 All Terrain Exploration 6330 Brewer Road 3/31/95 Contractor „t.' nrIl'li ngAddress Vl as can, Qrnvpr ('A License No.(r,1y,37A 3h Phone /Ota TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of service well ❑ r PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring well ICj I DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA DISPOSAL FLO.�_ PROP. LINE 1�_ FOUNDATION � AGRICULTURE WELL 600' OTHER WELL 294 PITS/SUMPSIS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca - Lia. of Well Excavation 8 in. Dia. of Well Casing 211 'T.n. CJ Domestic/Private L4 Gravel Pack7 ❑ Tracy Type of Casing PVC Specifications SPH 410 PVC I'I Public :fl Other= ❑ Delta Depth of Grout Seal 34' . Typo of Grout(]amen { I I Irrigation 4�Approx. Depth I I Eastern. Surface Seal Installed by TRANS TECH Repair Work Done U Type of Pump NA t H.P. State Work Done_ Wall Destruction ❑ Well Diameter Sealing Material i Depth Depth Piller Notarial a Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADOITION I I DESTRUCTION 1 1,(No septic system permitted if public sower is .- —�• - available within 200 fel Installation will sores: Residence_ Commercial_ Other Number of living units: , Number of bedrooms Character of sod to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartlrrnts PKG. TREATMENT PLT. ❑ ' Met t AisAfseatesA�� I Distance to nearest Well Foundation Property Lit ��VV�E��1��D LEACHING LINE Cl No. d Length of lines Total length/size mpix 1994 FILTER BED ❑ Distance to nearest: Well Foundation PropernSYA of )NTY . pgLre-I tcRc�Tl I 1; SEEPAGE SEEPAGE PITS 1 ) Depth - Size Number� .H€ACTH I)IVISION SUMPS LI Distance to nearest: Wall Foundation roperry Lina DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances. ,tate laws. an rules and regulations of the San Joaquin County Home owns,or licensed agem9 signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall no IIIIII employ any person in such monster as to Wcoma subject to workman's compensation laws of California." Contractor's hiring of sub-contracting signatur certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall amp"persons subject to workman's compenu tion laws of Cakfornla." The applicant mu ill r all required inspections. Complete drawing on reverse side. .q Signed Tiittlle�: Viirp Prpcitipnr Date: 1 Ja s C. Sauce INT O D� "Si��'EN7 USE ONLY Application cepted by Date /n /�7-n" Area r1 Pit or Gr t Irnpectbn by Date mel Inspection by `7--cam.. '2" Ce-j Defy I Additional Comments: �Q 4 Applicant - Return all copies to: San Joaquin ounty Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 fEE AMOUNT DUE AMOUNT REMITTED C K RECEIVED BY DATE PERMITNO. INFO (''�Q Ill—,/A . EH 1174 IRV,119 511, FF , ; /, © � /02 ��/. ,/