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' APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P 0 BOX 2009, STOCKTON, CA 95201 (209) 468-3447 PERMIT EXPIRES 1 YEAR PROM 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 made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services, Job Address 450 E-. Grantline Road City Tracy _ _ Lot Size/Acreage 10 acres 913 Owner's Name Doane Products Cala anyddrBss 450 E•. " Grantline Road Phone(209) 83 -X212 Contfactor SR, ectrun Explorat Q, 2825 E. Myrtle, StOCAnse No.512268 Phone,(209) 465-8712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 25 ' SEWER LINES 5 ' DISPOSAL FLD, N/A PROP. LINE 200 t FOUNDATION 5' AGRICULTURE WELL ti3THER WELL100 PITS/SUMPS N/A INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation ILI inch Dia. of Well Casing 4 inch U Domestic/Private LN Gravel Pack XXTracy Type of Casing PUC Specifications SCh 40 M Public I'1 Other p Delta Depth of Grout Seal 5Type of GrouQement frit / Cl Irrigation Approx. Depth 11 Eastern Surface Seal Installed by Water Repair Work Done L] Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Filler Material A Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIRIADDITION L'i DESTRUCTION CI (No septic system permitted if public sewer is available within 200 feet.} Installation will serve: Residence— Commercial T 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 J PKG, TREATMENT PLT. ❑ Method of Disposal f� Distance to nearest: Well Foundation Property Line Y LEACHING LINE D No. b Length of lines Total length/size FILTER BED n Distance to nearest: Well Foundation Property Line / SEEPAGE PITS I I Depth Size Number SUMPS U Distance to nearest: Weil Foundation Property Line DISPOSAL PONDS ❑ ' I hereby comity 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 HOMO 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 workman's compensation laws of California." Contractor's hiring or sub-contracting signature comifies 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 taws of California." The applicant must all for all re fired inspections. Complete drawing on reverse side. Signed Title: u N I'AeA„AS;2',,,__,_._ Date: _2-i1-1 I ,�Q FOR DEPARTMENT USE ONLY r Application Accepted by / ^” '`r Date Pit or Grout Inspection b, Pte( Date Z Final Inspection by Date 2�� Additional Comments: AAA a— t r Applicant – Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOR 2009, STOCKTON, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEtVEO BY DATE PERMIT"NO. + EM 1]•2{INEV.I/M$lEK QU r+O /fit (� qt � ;{•1e V yfae, �J [