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APPLICATION WELL Ws 1 OF 3 SAN•OAQUIN COUNTY PUBLIC HEALTHRERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 C (( \t �� L!P 0 BOX 2009, STOCKTON, CA 95201 (\,J/f PERMIT EXPIRES 1 YEAR FROM DATE ISSUEn_ (Complete in Triplicate) Application 1a hereby made to Han 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. Joh Address 8751 E. Hwy 12 City Victor tot size/acreage + 20 k . - owners Name Dole Fresh Fruit Company Address Same Phone 209 34-2780 All Terrain Exploration 6330 Brewer Road 3/31/95 Conlracta I Drilling 'Address2Jeasanr Grn.+e, C4 License No.1,17336 Phone 0/ TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION ❑ Out of service well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA DISPOSAL FLO. NA PROP. LINE 10_ FOUNDATION — AGRICULTURE WELL 22r OTHER WELL 294 PITS/SUMPSI5 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca is. of Well Excavation Dis. of Well Casing V1 FA Domestic/Private 0 Gravel Pack ❑ Tracy Type of Casing_PVC Specifications SCT7_ 40 PVC I'I Public 1.1 Other fl Della Depth of Grout Seal 34' Type of Grout CPment I I Initiation 40tAPMox. Depth I I Eastern Surface Seal Installed by TRANS TECH ,— Repair Work Done ❑ Type of Pump NA H.P. State Work Dona_ f Well Destruction ❑ Well Diameter Sealing Material i Depth Depth Tiller Material a Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public saws, is available within 200 lest.) Installation will "me: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of soli to a depth of 3 feet: Water able depth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ Malt')g6Aiaasasi.L'G— Distance to nearest: Well Foundation Property LRH►l1 �EY��E��''aa �n LEACHING LINE ❑ No. 8 Length of linea Total length/size—my q R 1993 FILTER BED ❑ Distance to nearest: Well Foundation Property SA��(T1�Q )N1YTY 1QHTicTrFitETF� CFR - SEEPAGE PITS 11 Depth Sirs Number }Ep�T�E HFAI TH UIVISIOf•I SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this application end 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."Contractors hiring or subcontracting 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 applicant mar call 6r MI required inspections. Complete drawing on reverse side, a jpp Signed Title: Vire President Date: MAY 96 13 t73 Ja s C. Sauce n O DEPARTMENT USE ONLY Y- Application cap by ��FLrrLt( -- G/'L-SIAL? Dats ��-�.pY �)J Area t Pit or Gr t lapettbn DY ✓ Date final Inspection by `7 -r✓K '///`-"Z„ lre1 Dete ! n �) Additional Comme tts: L'O-( iti 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 FNFO EE AMOUNT DUE AMOUNT REMITTED C KI RECEIVED BY DATE PERMIT NO. pqq�� F c t'1' . (/1 . EH 13-N INEV.,/nmtu'A Fy n F/ o EH 1631 1