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APPLICATION { SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCXTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application in hereby made to San Joaquin County for a permit to construct and/or install the vork herein described This application is made in compliance with San Joaquin County Ordinance No 549 and 1862 and the Rules and Regulations of San ' Joaquin County Public Health Services 450 E. Grantline Road Tracy Lot Size/acreage 10 acres Job Address City ' Doane Products Co . Address 450 E. Grantline Road Phone (209) 835-9133 Owner s Name (2 Q 9165-8712 Contractor License hos Spectrum Explorat�,�ss 2825 E Myrtle,Stock. 12268 Phone 4 TYPE Of WELL/PUMP NEW WELL ❑ WELL REPLACEMENT P DESTRUCTION a Out of Service Well 0 ' PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST SEPTIC TANK 25 i SEWER LINES 251 DISPOSAL FLD n a PROP LINE 200 r r` FOUNDATION 25 ' AGRICULTURE WELL! M. BOTHER WELL 25 r PITS/SUMPS na ' SNTENOEO USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 2111 L-1industrial ❑ Open Bottom ❑ Manteca Dia of Weil Excavation Dia of Weil Casing Type of Casing PVC Specifications Sch. 40 fl Domestic!Private �Gravel Pack M Tracy g �+ ' i I Public n Other FI Delta Depth of Grout Seal 5 t Type of GrouC-Bentonite ntDrilte I I Irrigation _Approe Depth I I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H P State Work Done Weil Destruction Q Weil Diameter 211 Sealing Material i Depth ement/Bentoni. e ' e Depth 16 t Filler Material i Depth Sand pack (16 } TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I aNveifseptiablewsystem permi!emitted if public sewer is Installation mil 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 Olsianes to nearest Well Foundation Property Line ' LEACHING LINE Cl No & Length of lines Total length/size FILTER BED ❑ Distance to nearest Well Foundation Property Line ' SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest Well Foundation Property Lina DISPOSAL PONDS Cl ' I hereby canity 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 lowing 'I certify that m the pe`farmance of the work for which this perrrul is issued ! shall net Home owner or licensed agent a signature certifies the fol empioy any person in such manner as to become subject to workman s compensation laws of California Contractor s hiring at sub-conifacting signature certiftes the following I certify that in the parlormanca of the work for which this permit is issued,I shall ampicy persons subject to workman s compensa ' tion Tawe of California The applicant mu t c lI fo all req iced tions Complete drawing on reverse side ' /��.- v ��,tle Geologist/Brunsing Date 1/24/92 Signed X ASSoci-a eS , Inc- FOR DEPARTMENT USE ONLY Application Accepted by Date - Area ' Pit or Grout Inspection by Datey Final Inspection by Daatre/- Additionsi Cornnwnia Applicant - Return all copies to San Joaquin County Public Health Services 1 Environmental Health Permit/Services �CjJ 445 M San Joaquin, P o Box 2008, Stkn, CA 95201 FEE AMOUNT auE AMOUNT REMITTED C" '' RECEIVED BY OATE PERMIT NO INFO CASH /�/ �/,(� ^`� 9 � 2. x 1324 IiifV i/451 D vf �`� I EH 1420