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npT.IC�.'^?ONT SAN icAQUIN COUNTY PUBLIC HEALTH SERVICES i ENVIRONMENTAL HEALTH DIVISION ; 445 N SAN JOAQUIN, PHONE (209)468-3420 ' P O".BOig 2009, STOCKTON, CA 95201 4 PERMIT SIRES 3 YEAR FROM DAT9 ISSUED (Compieze in Triplicate) ' application is hereby made to San Joaquin County or a Permit to construct and/or install the work herein described. This application is rustle in compliance Vith San Joaquin county Ordinance tic. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Servicer:. Job Address Dividend Deveiopment Corporation_ ;;,ry Tracy Lot Size/Acreage Ar nrnx_ 100 arses i owner's Namr Dividend Dev. !Corp. address 3600 Drunerid e. Ave .Santa Clar.ainone � ??ancY:o Cordova, CA Contractor McLaren/-tart f iddress11101 White lock ' Dad, License f�1o.505932 e(21 61 638-36 6 TYPE OF WELL/PUMP: NEW WELL C WELL REPLACEMENT 1 DESTRUCTION G out of Service Well ❑ PUMP INSTALLATION C SYSTEM REPAIR C OTHER G Monitoring well DISTANCE TO NEAREST: SEPTIC TANK > lODD; SEINER LINES > 1000" i DISPOtSoIL, i o ;pn9l PFjOP. LINE �-600 r FOUNDATION 71D00 AGRICULTURE WELL710o0 OTHER WELL QITSCSUMPS P INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS industrial ❑ Open Bottom Manteca Dia. of Well Excavate n Inc es pia. of Well Cacti j11 ` Domestic/Private M Gravel Pack ri Tracy Type of Casing �� Specifications � - ' 3. eel cement/bentor tj Public l-1 Other Delta Depth of Grout Seal Typo of Grout,. $ re Drillin a i Irrigation 1 t�Approx. Depth t i Eastern Surface Seal fnstsilad b1G nd, It-gf-ing flepair Work Done u Type of Pump WP. State Work Done_ Weld Oestructiort O Well Diamear Sealing Material i Depth Depth Filler Material i1 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRIADDITION I 1 DESTRUCTION 1 I tNo septic system permitted if publicsewer is available within 200 feet.f .� Installation will save: Residence Commarciaf_ Other Number of living units: Number of bedrooms Character of jai to a depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments 'PKG. TREATMENT PLT.0 �{ Methad of D*xmai Distance to nearest: Well Foundation Property Line I LEACHING LINE ❑ No. & Length of lines Total lengthisize FILTER BED 0 Distsnce to nearest: Waif Foundation Property Line �1 i SEEPAGE PITS l 1 Depth Size Number SUMPS Ll Distance to nearest: Wen ' Foundation Property Line V DISPOSAL PONDS I hereby cenify that I have preparers this appWAtran and that the work wrk be done in accordance with San Joaquin county ordinances,state laws, and rules and regulations of the San Joaquin County Home owner or acarsaed agent's signature cendres the following: "I earthy that in the performance of the work for which this permit is issued. 1 shalt not empioy env parson in such meaner as to become subject to workmen's compensation laws of California.- Contractor's hiring or sub-contracting signature candies the followrq:"I certftY that in the pertormenee of the work for wnicn this permit is issued.1 shad employ persons subject to workman's compensa- tion laws of CaMomis." The applies must Call for all requued in paations. Complete drawing on reverse side. / y y -" Tide: SSoaervISli^� GPOSc16411�7 / Data: S II Z l Signed -T FOR DEPARTMENT USE ONLY Application Accepted by Date �2' Area Pit or Grout inspection by Data Final Inspection by Date Additional Comfnents: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services lir/ /�[� 445 N San Joaquin, P O Box 2009 tkn, CA 95201 !//i_r CP FEE AMOUNT DUE AMOUNT REMITTED s RE D BY DATE PERMIT NO. INFO EK il14 MOW.1 511!5V � EN t/•7e