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•«_ .1. a SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION l 445 N SAN JOAQUIN,' PHONE (209)468-3420 i P 0 BOX 2009, STOCKTON, CA 95201 -•-PERMIT EXPIRES I YEAR FROM DATE ISSUED `(Complete in Triplicate) rgam- 13c -y 2- Applicatloh is hereby make 'San quin 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. Howland Road near intersection of Job Address Hwy 120 and I-5 City Lathrop Lot Size/Acreage 536 acres 3825 Hopyard Road, #214 :. Owner's Name _Kearney Ventures, Ltd. ^ Address Pleasanton, CA 94588 Phone 510 847-8910 Earth Systems Consultants-;"Inc.. 4378 Santa Fe Road contractor Pacific Geoseience Div. Address San Luis Obispo, CA 93401 License No. 606513 Phone(805)544-6187 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT C1 DESTRUCTION D Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER L7n ung Well i i DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. IN FOUNDATION AGRICULTURE WELL OTHER WELL PITS/ LIMPS INTENDED US'E -'TYPE-OF WELL-"--PROBLEMAREA`"CONSTRUCTION-SPECIfIC'AT-IONS--- — ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation_8_inch Dia. of Well Casing 2 Inch KI Domestic(Private) "" XX Gravel Pack ❑ Tracy Type of Casing_ PVf. _ Specifications sP-P--attarhed_i L� Il Public fa Other fl Delta r,Depth of.Grout Seal 15-20' Type of Grout ement Slurry ;_—N I I Irrivation 20;,2 :Approx. Depth I I Eastern Surface Sedl Installed by entonite Repair Work Done L7 Type of Pump H.P, State Work Done C3 Well Destruction ❑ Well Diameter Sealing Material & Depth ' Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION i I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence T.'=Commercial_ Other 4 Number of living units: Number of bedrooms a Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK: ❑ Type/Mfg �} Capacity No. Compartments k PKG. TREATMENT PLT. ❑ Method of Disposal h Distance to nearest: Well r�Foundation Property Line - LEACHING LINE ❑ No. & Length of lines " Total length/size q FILTER BED 1-1 Distance to nearest: Well Foundation Property Line �I SEEPAGE PITS 11 Depth Size r Number SUMPS El 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, an. 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 parson in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature i 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 Cal' nla." a The applicant call far 1 e fired ' s ti ns. Complete drawing on reverse side. Signed Title: ro'ect Engineer Data. 3-26-92 OR ARTMENT USE ONLY ell Application Accepted by Date r^ rea Pit or Grout Inspection by Date Final Inspection b -✓1 Data 1� Additional Comments: I Opp ! Applicant - Return all copies to: San Joaquin County Public Health Services j Environmental Health Permit/Services 445 N San Joaquin, P O Sox 2009, Stkn, CA 95201 IFEE AMOUNT DU�EwA AMOUNT REMITTED Ctt 0 RECEIVED BY DATE PERMIT NO. • EK13.24(REV.t i K 51 vY y� EH 114.26 �~ —i ' 3 O