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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 made to San Jo .quin County for a permit to construct and/or install the work herein described. This application is made in comllaace with San Joaquin County Ordinance 9o. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Manteca Business Center Job Address 415 North `fain Straat city Manteca Lot Size/Acreage 128'x172' c/o Fisery Owner's Name Resolution Trust Corp Address 171 Tnt-arjtark #1 1(11 A, Phone(210) 491-7005 San Antonio, TX 78216 Contractor B&F Drilling, Inc. Address 3663 Omel Circle, #8 License No. C57-519428Phone (916) 631-9f 46 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ;,7 DESTRUCTION u Out of Service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER �9 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 Industriai ❑ Open Bottom Manteca Dia. of Well Excavation —inch Dia. of Well Casing 71 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications F1 Public 11 Other fl 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 _ Well Destruction ❑ Well Diameter Sealing Material i Depth Cement cyrout w/57. Bentonite to tots Depth Filler Material i Depth depth. TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted it 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 feet: 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 ❑ No. S Length of lines Total length/size FILTER BED ❑ Oistance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Sue Number SUMPS LI Distanca to nearest- Well Foundation Property Line DISPOSAL PONOS ❑ I hereby certify, that 1 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: "I 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 workmen's compensation laws of California." Contractor's hiring or sub-contracting signature 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 compensa- tion laws of California." The applicant must call of all required ,nspections. Complete drawing on reverse side. (Site Plan Attached) / ATEC Environmental Consultants Signed Title: Project Manager Date: 1/Tf 9'l_ i v `i DEPARTMENT USE ONLY Application Accepted by Date sa Pit or Grout Inspection by Date` Final Inspection by Date Additional Comments: Hydro�unch(s) .applicant - Return all copies to: Sam Joaquin County Public Health Services �HrJ7I tet/ Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEEAMOUNT DUE OlJNNTT //RJ� EMITTED C SN � rRECEIVEO BY I OAJTE PERMIT'NO. . EH 1]•71111N � .,��ei JS f • DO I U •0 V � /Q�� /� /�� 72 ,H 14.22 /1/