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APPLICATION • SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PAYMENT ENVIRONMENTAL HEALTH DIVISION RECEIVED N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 APR 2 6 1993 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES (Complete in Triplicate) ENVIRONMENTAL HEALTH AIVISIO�! Application is hereby made.to San Joaquin County for a permit to construct and/or install the work herein described. Th s 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 East Grantline Road City Tracy Lot Size/Acreage Owner's Nam Doane Products Company,ddre55 450 East Grantline Road Phone (209) 835-9133 Contractor Spectrum Explorat��,, 2825 E. Myrtle _License NOC-57 51.22�4one (209) 465-E712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 171 DESTRUCTION)I Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well (5 DISTANCE TO NEAREST: SEPTIC TANK 50 ft SEWER LINES 50ft 11D�IISPOSAL FLD.100ftPROP. LINE 100 ft FOUNDATION 5�f AGRICULTURE WELL 1 Mil&HER WELL 4 ft_.PITS/SUMPS 2..0.0 ft INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 2"/4" Cl Domestic/Private X1 Gravel Pack JZ Tracy Type of Casing__ PVC Specifications SCh 40 CI Public Cl Other n Delta Depth of Grout Seal 5ft Type of GroutiCement/Bent on i I Irrigation L7Approx. Depth 1 I Eastern Surface Seal Installed by S12pgtrum ExploratiQn Repair Work Done 0 Type of Pump NA H.P. State Work Done , Well Destruction CK Well Diameter 2 r' 2 4 r' (1)Sealing Material & Depth Depth 17.1 (3W91 1 S) Filler Material & Depth �56; 1 (1 fnn#-) 41 TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 1 I DESTRUCTION I I (No septic system permitted it public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial_ Other d Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth M SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. & Length of lines Total length/size FILTER BED 0 Distance to nearest: Well foundation _ Property Line SEEPAGE PITS I I Depth Size _ Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify 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 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 workman's compensation taws 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." f The applicant must call for all required inspections. Complete drawing on reverse side. t Signed X LJ f i * wa. Title: 6.\3 4 - Date: FOR DEPARTMENT USE ONLY rr G�j 5� OD`l�•"1� Application Accepted by r Date Area Pit or Grout Inspection by Date & D•R3 _ 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 CK RECEIVED BY DATE PERMIT,NO. INFO / �-y /� CASH �7 /may . £H 13.241REV.1/h51 J / / •� �U �_' MiO -yam �.�3-13 vl �_ EH 14,26 6)V llliVV/ !✓ r✓