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• APPLICtiTTON • SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICEI`VJlii_g2J'7E J ENVIRONMENTAL HEALTH DIVISION JJlliihh\\''VVV 445 N SAN JOAQUIN, PHONE (209)468-3420 *6 Soil Bar ngs to `�. 1 1J 1993 P 0 BOX 2009, STOCKTON, CA 95201 F E BAA W 3 dep th, 1 temporary well for EMAL HEAL7N PERMIT EXPIRES 1 YEAR FROM DATE ISSUEIIIIL VIRC"Er1?A Ntest. ENVIRM�TISERVICES (Complete in Triplicate) PERMIT/SERVICES 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. Ak - - Lot Size/Acreage 1400'x400 Job Address D� Ditrihution Pro Tt Ch CitY arnp ' 09) 982-2093 Ownefs Name U.S. Army Address DDRW Sharpe Lathrop. CA Phone 2 +35K Contractor & Accociatec Address Pleasanton 0A License No. 057490942 phone 51 46 -4 TYPE OF WELL/PUMP: NEW WELL IJWELL REPLACEMENT 71 DESTRUCTION ❑ Out of service Well ❑ PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHERXZ* Monitoring Well ❑ 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 N A ❑ Industnai ❑ n6 tn Open Bottom ❑ Manteca Dia. of Well Excavatioo 10 inch Dia. of Well Casing D Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ NSA Specifications I"1 Public X*pther Ll Delta Depth of Grout Seal 0-20 feet Type of Grout NPA Pm Pnt I l lfrigatlon —Approx. Depth Il Eastern Surface Seal Installed by B K & Acaocia ec Repair Work Done L1 Type of Pump NA H.P. State Work Done _ Well Destruction W Well Diameter to 1 0 inalWifg Material 6 Depth NA Depth Max. 0 Piller Material a Depth Neat cement g o tr,- It TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION 11 (No seplic system permitted it public sawet is available within 200 fast.I Installation will 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 Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest. Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 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 CFlffa�nia. ustThe applica c for regComplete drawing on reverse side. Signed x ni ins yi Title: Proiect Manager Date: 2/293 `' _ FOR DEPARTMENT USE ONLY Application Accepted by ' 1 .O.r/`��_LO-�7-c.t_7 Date �' Area Pit or Grout Inspection by Data 3� Final Inapeetion by Date 7 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 fi OUNT DUE AMOUNT REMITTED CASH RECEIVED By DATE PERMIT N0. / /� /��/EN 13.21(REV.i r.of $ [ -- `I ; 10 EN ta.2a