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` APPLICATIONt.W LL ?TJ`2 OF . } SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES YT — ENVIRONIMTAL 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 made to Sam Joaquin County for a permit to construct and/or install the work herein described. V application is made in ceeipliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Se Joaquin County Public Health Services. Job Address 8751 F H r 12 Clty ItiC.tOZ Lot Size/Acreage t 20 Ac. Owner's Name Dole Fresh Fruit CompanyAddress Same Perone (209) 334-2 All Terrain Exploration 6330 Brewer Road Contractor Drilling Address P1 Pasant Groyp, r'A License No. ##'47876 phone (Q7F410u 7�__ TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 7 DESTRUCTION L1 Out of Service Well PUMP INSTALLATION C SYSTEM REPAIR C OTHER ❑ Monitoring Well I DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA DISPOSAL FLO.N_ PROP. LINE -,Jai FOUNDATION NA AGRICULTURE WELL 800r OTHER WELL 471t PITS/SUMPS �r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industnal ❑ Op Boteom O Manteca Dia. of Well Excavation Oia. of Wsll Casing 2" I Gd Dorneatic/Patalla Q Gravel Pack ❑ Tracy Type o1 Casing_ PVC Specifications SCH 40 P PI Public I 1 Othar fl Delta Depth of Grout Seat 34 Type of Grout Cement - I I ueigation 40 Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump NA H.P. State Work Done _ Well Destruction O Wall Diameter Sealing Material a Depth Depth Piller Material A Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo optic system permitted if public sewer is -- available within 200 IeatJ Installation will serve: Residence _ Commercial_ Other PAYMENT yN,,p ELFT Number of living units: _ Number of bedrooms ®®P�A�Y++rN Ey�N 1 Character of soil to a depth of 3 feet: Waterstl0 SSWU n SEPTIC TANK D Type/Mfg Capacity No. C��s�rqp�rt PKG. TREATMENT PLT. C Met fad�is DTOAQ I 1993COUNTY I Distance to nearest: Wall Foundation ProfaerAtALIH ERVICES 4 LEACHING LINE C1 No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well ' Founcation -—Property Line 1 11, SEEPAGE PITS 11 Depth Size Number 11 SUMPS LI Distance to nearest: Well Foundation Property Line I DISPOSAL PONDS C _ I hereby certify that I he"prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, rules and regulations of the Sen Joaquin County Home owner or licensed agent's signature cartifies the following: "I certify that in the pulormance of the work for which this permit is issued. I shall employ any person in such manner as to become subject to workmen's compensation laws of California." Contractor's hiring or sub-contracting Signa 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 Comps .tion Iowa of California." `1 The applicant t cal or NI required inspection@. Complete drawing on raver" side. B 1 SignTitle: Vice President Date: MAY It ' Signed 1 nArl�es C. Saucerm FOR �,EP TMENT USE ONLY 9/1)_1 � /1 Applical Accepted by Due 1- Area Pit or rout Inspection by Date Find Inspection by �-Q� , Dau n � y � p r Addhional Comments: ✓j'I Grp C:R �c(Y •- 4.Cili"` . 2 ei 6 4 yq !�f1..2�/tfi .til Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services ,l" 445 N San Joaquin, P O Box 2009• Stkn, CA 95201 INFO AMOUNT OVE- . AMOUNT REMITTED I K I RECEIVED By I DATE PERMIT NO. . EM flea(REV,�r.slfr/Yrl _ _. _ 6ty3 l IN t4a