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• APPLICATION • WELL Pod 2 OF 3 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES �7 ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 L ZLlPERMIT E%PIPES 1 YEAR FROM DATE ISSUED J (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. Lot Size/Acreage + 20 AC. Job Address 8791 F Hwv 17 City li' r..r Dole Fresh Fruit yAddress Com an Same Phone (209) 334-278 Company Owner's Name All Terrain Exploration 6330 Brewer Road Convaclo, Drilling Address pleasant- I E'A License No. fiZ „17836 'Phone - 9 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 11 DESTRUCTION ❑ Out of Service well ❑ SYSTEM REPAIR ❑ OTHER ❑ monitoring well PUMP INSTALLATION ❑ _ DISTANCE TO NEAREST: DISPOSALNA SEWER LINES NA PROP. LINE FOUNDATION NA AGRICULTURE WELL 3.02 OTHER WELL PITS//SUMPS 1S.r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 2n I.D. Dia. of Wall Casing fl Industrial ❑ Open Bottom ❑ Manteca Die. of wall Excavation PVC SCH 40 PVC Type of Cesin Speaficatbm fjl Domestic/Privsta §l Gravel Pack L7 Tracy 9- 3— 4 Type of Grout Cement I'I Public 140 Other n Delta Depth of Grout Seal Irngandn —App, Depth I I Eastern Surface Seal Insiallad by Repair Work Done U Typo of Pump NA H p —_ State Work Don"I"t.)Sealing Material a Depth Wsl1 Oostruclion ❑ Well Diameter Filler Material a Depth Depth TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No "plliavailable Installation will wrve: Residence _ Commercial _ Other Number of living units: __ Number of bedrooms tl Character of saH to a depth of 3 feet: Water W SEPTIC TANK ❑ Type/Mfg Capacity No. C�e'rh1wtr7re PKG. TREATMENT PIT. EI Props of DiL "I $�I JOA6' IN COUNTY Distance to nearest: Wait Foundation Prop° UBL�CFfEALTTFSERVICES LEACHING LINE ❑ No. 5 Length of lines Total length/size FILTER BED n Distance to nearest: Well Foundation Property Lino SEEPAGE PITS II Depth Size Number SUMPS LI Distance to nearest: WellFoundation Property Line DISPOSAL PONDS ❑ I hereby comfy 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 undies the following: "I certify that in the performance of the work for which this permit is issued. 1 shall not workmen's compensation laws of California." Contrector's hiring or subcontracting signature employ any person in such R1anMI es to become subject to cenifles the following: "I certify that in the performance of the work for which this permit n issued. I shell employ persons subject to workman's compacts tion hi of California." pp �1i, .f F] The applicant 1 pal or all required inspections. Complete diewing on reverse side. MAY N 6 I�a Signed Title: Vice President Date: es C. Saucerm FOR DEP RTMENT USE ONLY /y� c ' Appi,cn Accepted by �lr / ;", i �`2 .l Data / Area ? q -� 1, Date Final Inspection by � �/ /�Yi - Ditto Pit or rout Inspection by 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 FEE CK I RECEIVED gY DATE PERMIT N0. AMOUNT DUE AMOUNT REMITTED ASH INFO Li C C' L9 0 . EM I1.21IAN ,,.,, 5 EM 11-a1 '