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nnpr ICnm'Q*laO V S z`J' 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 JI''I`' �I 1 � A§5 (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work here , "Jill � application ie made in eoailiance with Ban Joaquin County Ordinance No. 51r9 and 1862 and the Ru NO 1'tris Joaquin County Public Health Services. les and Regulations of San Job Address 6649 Embarcadero Drive - Cit Stockton N/A Y _ Lot Size/Acreage _ Pegasus Group 1148 Alpine Road Owner's Name Address Walnut Creek_ CA 94596 Mitchell Drilling & P.O. Box 2231 95741 Contractor Environ. Corp. Address Rancho Cordova CA License No. 672617 TYPE OF WELL/PUMP Phone(510)930-081C Phone (916) NEW WELL WELL REPLACEh1FNT fl DESTRUCTION Cl Out of Service Wr U Well [-1 PUMP INSTALLATION SYSTEM REPAIR Cl OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE (2 ) FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA Cf Industrial I 1 Domestic/Private I'I Public I I Irrigation Repair Work Done U Well Destruction ❑ YPE OF SEPTIC WORK _ CONSTRUCTION SPECIFICATIONS O Open Bottom ❑Manteca Die. of Well Excavation Dia. of Well Casing 2 " C) Gravel Pack O Tracy Type of Casing --5-0b 40 PVC 0 L " 1 o t s Specifications' s r X1 Other Mon i torj(-vDalta Depth of Grout Seal _ _ Approx. Depth I I Eastern Surface Saul Installed by Type of GroutPortland Type of Pump H. P. State Work one _ Well Diameter Sealing Material & Depth bentonite & cemen grou Depth Filler Material & Depth#3 Monterey sand 10-35 ft NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic s stem d'f Installation will serve: Residence — Commercial Number of living unite: Number of bedrooms Character of Boll to i depth of 3 feet: SEPTIC TANK O Type/Mfg PKG. TREATMENT PLT. d Distance to nearest: Well LEACHING LINE Cl No. 14 Length of lines FILTER BED C) Distance to nearest: Well SEEPAGE PITS I I Depth —_Sire SUMPS LI Distance to nearest: Well DISPOSAL PONDS O Y perm ie r pubhe sewer is available within 200 feet.) Other Water table depth _ Capacity No. Compartments Method of Disposal Foundation Property Line Total length/size— Foundation _ Property Line Number Foundation _ Property Line r nereoy certity that 1 have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, a rules and regulations of the San Joaquin County nd Nome owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this perrnit is issued, I shall not employ any person in inch manner as to become subject to workmen's compensation laws of California." Contractor's hiring or sub -contracting 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 u t call for all required ins pe ions. Complete drawing on reverse side. W . W . Irwin, Inc. Signed X- Title: Senior Geologist Application Accepted by Pit or Grout Inspection by Additional Comments: Ibl}: Date: June 14, 1995 FOR DEPARTMENT USE ONLY /D J Date " �✓ Area Data Final Inspection by — Date" Applicant - Return all copies to: San Joaquin County Public Health Services Environmental llealth prrmit/Services 445 N San Jonquin, P 0 Sox 2009, Stkn, Cft 95201 FEE I AMOUNT DUE AMOUNT REMITTED INFO . CASH RECEIVED BY DATE EH1114InEv.ri.sr TH 14 26 Gk �/ JYS K)