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1 ` APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT PAYMENT 1601 E. HAZELTON AVE., STOCKTON, CA RECEIVED Telephone (209) 4'661 460'3000 � P1 p p ; A 2 f fT-0 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED SAIN JOA 7, , -,'N NTY FOR SOIL BORINGS (Complete in Triplicate) PUBLIC I"! ' !' ';� ,1VICES Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein descrtibec rltlW; rAWQM is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address 500 EAST GRANI'LINE ROAD City TRACY Lot Size 150'x150' pM Owner's Name MOBIL OIL CORPORATION Address 3800 W.ALAMEDA,STE.700,BLh2BAl�TfC Phone 818-953-2626 kle4_14- ZM 4 Contractor�V GDOSCIENCE Address 1000 BUR= STE.140 CONCORD No. 569462 Phone 415-682-15$ TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER XI SOIL BORINGS DISTANCE TO NEAREST: SEPTIC TANK 1 mile SEWER LINES -_ DISPOSAL FLD.1 milePROP. LINE 180' FOUNDATION —L5.0 r AGRICULTURE WELL 0.5 F[i1 q!HER WELL !—Mil—e— PITSISUMPS 0.5 miles INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS (BORINGS) EI Industrial El Open Bottom 11 Manteca Dia. of Well Excavation Dia. of Well Casing N/A ❑ Domestic/Private N/A❑ Gravel Pack )7 Tracy Type of Casing NIA Specifications N/A1 '1 Public Cn Other ❑ Delta Depth of Grout Seal 1 0 t Type of GroAMT CECT_ •i I Irrigation --Approx. Depth I I Eastern Surface Seal Installed by NIA 'Repair Work Done ❑ Type of Pump H.P. NIA State Work Done DRILL SOIL BORINGS TO Nell Destruction ❑ Well Diameter Sealing Material Itop 50'} 10 DEPTH—GROUT WITH NEA t Depth Filler Material (Below 501 N/A CEMENT. __ TYPE OF SEPTIC WORK: NEW INSTALLATION l I REPAIR/ADDITION l I DESTRUCTION f I (No septic system permitted if public sewer is V I available within 200 feet.) (} Installation will serve: Residence_ Commercial Other () N/A Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG, TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of tines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line N/A SEEPAGE PITS I I Depth Size Number SUMPS L1 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 Local Health District. 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 laws 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." The appli m st c I r II required inspections. Complete drawing on reverse side. Signed ALTON GEOSCIENCE Title: PROJECT MANAGER Date: 3-16-90 Fd0;R&,;�AAE NNLY L r r Application Accepted by u Date Area Pit or Grout Inspection byf Date /`G'�6 Final Inspection by Date � � Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH CK RECEIVED BY DATED PERMIT'NO. + EH 1 -241pEv,5/x51 t C7J EH 144-2a