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SAN SAQUIN COUNTY PUBLIC ENVIROMISNTAL HEALTH D 0 445 N SAN JOAQUIN, PHONE ( P 0 BOX 2009, STOCKTON, P IT EXPIRES 1 MR FROM (Complete in Tripl c Applicatioa is hereby mile.to San Joaquin County for a peratit to coastruc snUcation is suds in compliance with San Joaquin County Ordinanes No. Sk9a o s Joaquin County Public Health Services. mom SIM- Job Address 23390 FLOOD ROAD City LINDEN Lot size/Acreage APPROX. 26 ACRES Owner's Name HYPONEX CORP. Address 23390 FLOW ROAD Phone (209) 887-3845 112 CENTER AVENUE Contractor GREGG DRILLING Address PACHECO, CA 94553 License No. 485165 Phone (510) 680-444 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT CI DESTRUCTION ❑ Out of Service Nall O PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ S. BORINGS OTHER M Monitoring Nell ❑ DISTANCE TO NEAREST: SEPTIC TANK > 50' SEWER LINES >50' DISPOSAL FLO. 250' PROP. LINE >50, FOUNDATION 50' AGRICULTURE WELL 75' OTHER WELL 75' PITS/SUMPS X50' INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 5 SOIL BOR I NGS TO 40 FEET 0 Indust" O Open Bottom ❑ Manteca Ole. of Well Excavation Dia. of WON Casing NA n Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing NA Specificatior►s NA I'1 Public n Other n Delta Depth of Grout Seal NA Type of Grout NA 1 I Irrigation _Approx. Depth 1X1 Eastern Surface Seal Installed by NA Repsir Work Done ❑ Type of Pump NA H.P. State Work Done 5 SOIL BOR 1 NGS Well Destruction ❑ Well Diameter NA Sealing Material i Depth 5% BENTONITE CROUT TO SURFACE Depth NA Miller Material i Depth NA TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIR/ADDITION I I DESTRUCTION I 1 fNo septic system pertitted if public sewer is available within 200 feet.) InstaNation wM serve: Re6denee_ 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 UNE 0 No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Wall Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 hereby cettity 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 Monte 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 shah not employ any person in abet manner as to became subject to workmen's compensation laws of California." Contractor's hiring or subcontracting signature certifies ter fallowkW."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 Callfonnla." The applicant tion. Complete drawing on reverse side. Signed X rte: REGISTERED GEOLOGIST Date: 3/31/94 FORD PARTMENT USE ONLY Application Accepted by Date / Area 04y f Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED 9 RECEIVED BY DATE PERMIT'NO. INFO . EH 1124(REV.I/n am — EH 14.2• 2� I