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SAN !UIN COUNTY PUBLIC HEALTH 1 'ICES Well No. 1 & 2 1!2IVIRONMENTAL HEALTH DIVISION_ 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM 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 2r Chrisman Road Gay Tracy Lot Size/Acreage 448 acres Owner's Name U.S. Defense Depot-TraCyAddress Tracy, California Phone (209)832 9532 Water Development 1202 Kentucky Avenue (916) Contractor Corp. Address Woodland, CA 95695 License rve. 283-326 Phone 662-1592 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT l^ DESTRUCTION Out of Service Well `, PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C7 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP LINE FOUNDATION AGRICULTURE WELL OTHER. WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing [I Domestic/Private ❑ Gravel Pack L7 Tracy Type of Casing_ Specifications I'1 Public F1 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done Ll Type of Pump H.P. State Work Done _ trrr rr Se ling Material Depth Meat Cement: 0 to 2 ft/o t0 166 ft� Well Destruction B Well Oiameterl 4 18 (� Well No. 1/Well No•ft/166pth 7 3 2 f f t. Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION i I DESTRUCTION i 1 .No septic system permuted if puohc sewer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number of living units: Number of bedrooms Character of soil to ■ depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/size ,V 47 FILTER BED Cl Distance to nearest: Well Foundation PropertRM,GE 1 V, SEEPAGE PITS ll Depth Size Number , SUMPS LI Distance to nearest: Well Foundation Pro#pXN Ql^D$,Q1'�r`1 DISPOSAL PONDS O pUP, I�, I hereby certify that I have prepared this application and that the work will be done in accordance wt* , YQJin co"Si 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 workmen'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 womman's compensa- tion laws of California." The applica ust call for all req .red inspections. Complete drawing on reverse side. �q r Signed X Title: 1755i� i��®ro(ect ger/%"'Sate: FOR DEPARTMENT USE ONLY ��J 7 Applic tion Accepted by Date / ` Area � (� by by .� ,� t� — Final Z� 'd�`�cLC-CDate Pit or Grout Inspection �� "�` �� Date _ nal Inspection by Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services S 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 S FEE AMOUNT DUE AMOUNT REMITTED CK III RECEIVED BY DATE PERMIT NO. v INFO CASH • EN 174 (REV.I/It 51 $60.00o- FH 14.28