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• APPLICATION • WELL MW — 3 OF, 3 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420F7 P O BOX 2009, STOC%TON, CA 95201 � ( PERMIT EBPIRES 1 YEAR FROM DATE ISSUED (�/�\``./)) tLti (Complete in Triplicate) Application is hereby made,to Ban Joaquin County for a permit to construct and/or install the vork herein described. This application is made in compliance with San Joaquin County Ordinance No. 5k9 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. + 551 E. Hwy 12 City VICCOT Lot Size/Acreage— 20 AC. Job Address $7 _ Owner's Name Dole Fresh Fruit Company Address Same Phone209 334-2780 All Terrain Exploration 6330 Brewer Road " 7$36 — 49 Contractor Drilling Address Pleasant Goye CA License No.#4 Phone — TYPE OF WELL/PUMP: NEW WELL ❑ ELL REPLACEMENT I I DESTRUCTION ❑ Out of Service Well 3f W Monitoring Well PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ 170' DISPOSAL FLO. NA PROP. LINE DISTANCE TO NEAREST: SEPTIC TANK N SEWER LINESMo r- 00 FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS= INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS rr I D Cl Industrial ❑ Upon Bottom ❑ Manteca Dia. of Wall Excavation PVCn. Specs. /lcatbnCasing sa- SLH 40 PVC �1 Domestic l Private CXGravel Pack 0 Tracy Type of Casing_ I'1 Public 1:1 Other fl Delta Depth of Grout Seal 34' Type of Grout Cement I I Irrigalion 4O Approx. Depth I I Eastern Surface Soul Installed by TRANS TECH — Repair Wort Done U Ty"of Pump NA H.P. -— _ State Work Done Sealing Material i Depth Well Destruction ❑ Well Diameter Filler Material a Depth Depth - TYPE OF SEPTIC. V.10-K: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I ahvailabe within 200 last'lO septic system ed 11 public newer is N r Installation will serve: Residence_ Commercial_ Otlror Number of living units: __ Number of bedrooms Character of wil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments Method of Pi PKG. TREATMENT PLT. ❑ Distance to nearest: Well Foundation Property Line DIVED LEACHING LINE ❑ No. g Length of lines Total length/size—MAY 9 6 1,993 1�1 FILTER BED n Distance to nearest: Well Founastlon Property Lir!1AN4GAQ64N COUNTY OI IRI iC HP Al TH CFRVICGS SEEPAGE PITS 11 Depth Sue Number ENVIRONMENTAL HEAL H DIVISION 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 accortlance with San Joaquin county ordinances, state laws, end rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the perlormance 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 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 workmen's compensa. tion laws of California," pp {� Q The applicant at I for all required inspections. Complete drawing on reverse side. 03 MAY Its t+ Signed X ✓�it�!/! Title: Vice President Data: ames C. Saucerma FOR EPARR`T�,MEEEN`TT USE ONLY Applics o AcceptedbV �,"j,ly/�D(1't.f V/ J 7 Date k'/ Mes—"/.��--�� lW�l9�i1 Pit or Grout Inspection by Dais r Final Inspection by r�� / �,12�2 Date IlL•�• ,Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 H San Joaquin, P O Box 2009, Stkn, CA 95201 FEEAMOUNT OtlE AMOUNT REMITTED C� RECEIVED By DATE PERM11 NO. INFO _ 9 EH 13 24 IREV 11x,. ,,,