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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION l� . '445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 ' PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to S I 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 1$62 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 500 EAST LOU I SE AVENUE City LATHROP Lot Size/Acreage 177.6 ACRES L I BBEY OuVENS FORD COMPANYAddress SOC EAST LOU I SE AVENUE Phone 209/85 3-5151 t Owner's Name License No. Phone 209/465-871 Contractor SPECTRfUM EXPLORATLic ION Address 2825 EAST MYRTLE STREET 52268 TYPE OF WELL/PUMP: NEW WELL C3 WELL REPLACEMENT [I DESTRUCTION ❑ Out of service Well ❑ SOT OTHER M Monitoring Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ BOR I N DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION _ AGRICULTURE WELL OTHER WELL PITS/SUMPS f INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 4 I NCI IES I H Dia. of Well Casing Ll industrial ❑ Open Bottom a Manteca Dia. of Well Excavation F WORK PLAN f7 Domestic/Private ❑ Gravel Pack❑ Tracy Type of Casing PVC Specifications��.. I'I IrriIa Other Fl Delta Depth of Grout Seal 5 FEET __ Type of Grou AT CITU /B ITE at , I I Irrigation 20 Approx, Depth l I Eastern Surface Seel Installed by SPECTRUM EXPLORATION Repair Work Done D Type of Pump NA H.P. N/A State Work Don �X Sealing Material & Depth BENTON 1 T TO U. Well Destruction ❑ Well Diameter 2fl N/A 0 Depth _... Filler Material & Depth 4 TYPE OF SEPTIC WORK: NEW INSTALLATION l I REPAIR/ADDITION I I DESTRUCTION l I Mo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence Commercial Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK. I❑ Type/Mfg Capacity No. Compartments �1 PKG. TREATMENT PLT. ❑ i Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size r FILTER BE 0 Distance to nearest: Well Foundation Property Line NA SEEPAGE PITS 11 Depth;f Size Number I SUMPS N/A LI Distance to nearest: Well Foundation Property Lina DISPOSAL PONDS Cl i 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 rules and regulations of the San Joaquin County Home owner or licensad 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." Contractor's hiring or sub-contracting signature o certifies the following: "1 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." I The applicant mu call fa I requir Inspections. Complete drawing on reverse side. 6/9/92 k Title: ACTING ENVIRONMENTAL Date: Signed t RD I NATOR FOR DEPARTMENT USE ONLY F � � Date � Area Application Accepted by Pit or Grout Inspection by 1 Date Final Inspection by Dat I Additional Comments: 'I Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services I 445 N San Joaquin, P O Boz 2t]09, Stkn, CA' J95201 I FEE AMOUNT DUE AMOUNT REMITTED R ERVED fay DATE PER N0. f INFO 4" EM 13.24 1REV.0 51 lJt_l S/ U(1 i l�V f !I •`!4T EH 14-2a