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w APPLICATIONE1G] LL14 3.OF�3 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) I Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application Is made in compliance:with San Joaquin County Ordinance No. 51x9 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 8751 E. Hwy 12 Victor + City Lot Size/Acreage— 20 AC. Owner's Name _Dole Fresh Fruit Company Address Same All Terrain Exploration 6330 Brewer Road Phone 209 334-2780 Contractor Drilling Address Pleasant Gove. CA License No.16437836 4 Phone ,. TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ['i DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Vali Ll} DISTANCE TO NEAREST: SEPTIC TANK — SEWER LINES Nom_ DISPOSAL FLO,NA r PROP. LINE 1 0, FOUNDATION AGRICULTURE WELL OTHER WELL 300 PITS/SUMPS 15 INTENDFO USE - TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ mdutltriel ❑ Open Bottom ❑ MantecaDie. of Well Excavation ln. Dia: of Well Casing 21' I D. I'l Domestic/Private L$Gravel Pack ❑ Tracy Type of Casing_ PVC SpecificationsS1214. (' . GO PV I'I Public (-I Other n Delia Depth of Grout Seal 34' I Irrga ion 40 A Type of Grout Cement ppox. Depth I I Eastern Surface Seal installed by TRANS TECH � Repair Work Done L7 "Type-,of Pump NA N.P. Scats Work Dons_ Well Destruction ❑ Well Diameter Sealing Material a Depth Depth Piller Material i Depth ,. TYPE OF,SEP7lr WORK. —NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No sedge system termitted it public Bawer is Installation will serve: Residence_ Commercial__ Other available within 200 feet.) (� Number of living units: _ Number of bedrooms Character of wit to a depth of 3 feet: Water table depth PKG. TREATMENT PLT. [1-SEPTIC TANK ❑ Type/Mfg 'Capacity No. Compartments i Method of- �i EIVE® Distance to nearest: Well Foundation Property Lina .� _ LEACHING LINE ❑ No. 8 Length of lines MAY 7 FILTER BED 993 ize-- In f ❑ Distance to neared Well Total length/a Foundation Property Li r5AN-38AQ1i1P1 COUNTY SEEPAGE PITS t I DOPth Sire — Number F r`,[1 I IC Hr H -URVICFS DIVISION SUMPS LI Distance to nearest: Well Foundelion DISPOSAL PONDS ❑ Property Line 1 hereby conify that I hove prepared this application and that the Work will be done in accordance with San Joaquin county ordinances, state jaws, and rules and regulations of the San Joaquin County - Home owner or licensed agent's signature certifies the following: "t cenify.that in the Penormance of the work for which this permit is issued, I shall not employ any person ins such manner ^o become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature cenilies the following: performance of the work for which this tion Iowa of California." permitis issued, 1 Snell employ persona subject to workman)cdmPenaa The applicant at I for all required inspections. Complete drawing on reverse side. Signed pTf pp p Title: Vice President Date: MAY RI 6 19�3 aures C. Saucermaan FOR/DEPARTMENT USE ONLY Applies o Accepted by .V�.�j, i.Al r t--, Date �r Area - ` Pit or Grout Inspection by Date 'f.C� 222 A—t A ��G / Final Inspection by_ Date Additional Comments: l Applicant - Return allcopiesto: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOVNT REMITTED CK INFO RECEIVED BY DATE PERMRNO. FM 1']24 IAN,v w s)