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al,ar.IC�,TTn.r SAN JUaQUIN COUNTY PUBLIC HEALTH SL1iVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT =IRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is aade in compliance with San Joaquin County Ordinance 9o. 549 and 1662 and the Rules and Regulations of San Joaquin County Public Health Services. Manteca Business Center Job Address 415 North 'fain Street City Manteca Lot Size/Acreage 128'x172' c/o Fisery (210 491-7005 Owner's Name Resolution Trust Corp Address 1 21 Tnternark /F1 1 Al A, Phone San Antonio, TX 78216 Contractor B&F Drilling, Inc. address 3663 Qmel Circle, ?�8 License Ivo. C57-519428Phone (916) 631-9!46 TYPE OF WELL/PUMP, NEW WELL ❑ WELL REPLACEMENT ::I DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR u OTHER �§ Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrial ❑ Open Bottom Manteca Dia. of Well Excavation —inC Dia. of Well Casing M Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications 1'1 Public 11 Other 1 Delta Depth of Grout Seal Type of Grout Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done _ Wed Destruction ❑ Well Diameter Sealing Material i depth Cement arms w/5% Bentonite to tota Depth Filler Material i Depth depth. TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/AODITION 1 I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feat: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. O Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Wed Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line 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, state laws, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation Laws of California." Contractor's hiring or sub-contracting signature certifies the following: "1 candy that in the performance of the work for which this permit Is issued, I shall employ persons suoleet to workman's compensa- tion laws of California." The applicant must call fof ad regWrad spections. Complete drawing on reverse side. (Site Plan Attached) ATEC Environmental Consultants Signed Title: Project Manager Date: DEPARTMENT USE ONLY Application Accepted by Date h7hptea Pit or Grout Inspection by Date Final Inspection by Data Additional Comments: Hydropunch(s) Applicant - Return all copies to: San Joaquin County Public 3ealth Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201FEE INFO AMOUNT DUE OUNT REMITTED CASH I RECEIVED BY DATE QJP•ERMIT�NO. EM 13.24 IIItY.it ei oo � V 0 /Q�I / !� /� !2- EH 14.26