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H nnpl.IC SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ' 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made.to San Joaquin County for a permit to construct and/or install the xork 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. 1100 acres IfCity Tracy Lot Size/Acreage Job Address 20500 Holly Drive 11 P.O. Box -60 Txacy Owner's Name Holl CA 95378 Phone 209 835-3210 Ho17 Sugar cor Address k T,n 582205 Phone 916 755-3745 El1VirOTllIlp_I1tc1Z� Ej?1% R%dress N R3. Yt1xR Ci License No. Contractor DESTRUCTION ❑ Out of Service-W,110 TYPE Of WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT C7 Monitoring Well SYSTEM REPAIR C7 OTHER ❑ PUMP INSTALLATION ❑ 50 ft, DISPOSAL FLD. PROP. LINE SEWER LINES --- DISTANCE TO NEAREST: SEPTIC TANK AGRICULTURE WELL _ OTHER WELL PITS/SUMPS FOUNDATION TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 411 INTENDED USE �'- Dia. of Well Excavation �- Dia. of Well Casing E7 industrial ❑ Open Bottom ❑ Manteca PZ Specifications Type of Casing_ Cl Domestic/Private Gravel Pack ❑ Tracy Depth of Grout Seal, I O - Type of Grout i'I Public (-I Other i 1 Delta I I Irrigation 25t.Approx. Depth I 1 Eastern Surf ace Seal Installed State Work Done F of Pump H.P. Repair Work Done 0 Type Sealing Material i Depth r ` Well Destruction ❑ We11 Diameter ��--- Filler Materiel i Depth V� Depth septic system YPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITIDN l I DESTRUCTION l l available within 200 feet-1 ed if public sewer is ii Commercial Installation will serve: Residence Commercial Number of living units: 'I Number of bedrooms Water table depth Character of soil to a depth of 3 feet: No. Compartments SEPTIC TANK. O Type/Mfg Capacity Q i 1Method of Disposal PKC. TREATMENT PLT.❑ Property Line Distance to nearest: Well Foundation �l Total length/size LEACHING LINE ❑ No. 8 Length of tines Property Line FILTER SED Ll Distance to nearest: Foundation Welt -v � 11 SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line k 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, and t rules and regulations of the San Joaquin County llowing: "i certify that in.the performance of the work for which this permit is issued, I shall not Home owner or licensed agent's signature certifies the to 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:111 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." ii The applicant mut call for all require i specti Complete drawing on reverse side. 2- -Fr,' Signed Title: 1 r",r /'Q ,-5r Date: I r FOR DEPARTMENT USE ONLY ��rrll��,�_Ty I Dace � �/ Area � Y�"� Application Accepted by 11 qL ;Z- � Pit or Grout Inspection by Date �" Final Inspection by A �'�� - Date Additional Comments: WSanity , Health Applicant - Return 'all copies to: Joaquin Cul EnvironmentaloHealthublic Permit/Servicesvices 445 N San Joaquin, p O Box 2008, Stkn, CA 85201 F EECK 111 7 RECEIVED BY GATE pERMIT'NO. FOTAMOUNT:�Dt:JE__ AMOUNT REMITTED CAS4� IL_ to EH 13.74 4REy.,i ns, 05 tC ----- -- _-....---- -- - -