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SAN JOAQUIN COUNTY PUBLIC HEMIREM ENVIRONMENTAL HEALTH D,V, 445 N SAN JOAQUIN, PHONE (209)46 P O BOX 2009, STOCKTON, CA 95 (Complete in Triplicat Application is hereby made to San Joaquin County for a permit to construct andJi5?- tT1 application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 Joaquin County Public Health Services. o�,�an n nnn Dnan LINDEN ©0 1.M 1,i2 /Al AVP APPROX. 26 ACRES Job Address AMOUNT DUE -- Owner's Name HYPONEX CORP. Address 23390 FLOOD ROAD Phone (209) 887-3845 PERMIT NO. 112 CENTER AVENUE Contractor GREGG DRILLING Address PACHECO, CA 94553 License No. 485165 Phone _ ( 510) 680-444 TYPE OF WELL/PUMP, NEW WELL ❑ WELL REPLACEMENT 1l DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ S. BORINGS OTHER r Monitoring Well C7 DISTANCE TO NEAREST: SEPTIC TANK i 50' SEWER LINES i 50' DISPOSAL FLD. 250' PROP. LINE >50' FOUNDATION 50' AGRICULTURE WELL 751 OTHER WELL75� PITS/SUMPS X50' INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 5 SOIL BORINGS TO 40 FEET O Industrial El Open Bottom 11 Manteca Dia. of Well Excavation Dia. of Well Casing NA I I Domestic/ Private ❑ Gravel Pack ❑ Tracy Type of Casing_. NA Specifications NA I'I Public 1-1 Other P Delta Depth of Grout Seal NA — Type of Grout NA 11 Irrigation — Approx. Depth IXI Eastern Surface Seal Installed by NA Repair Work Done 0 Type of Pump NA H. P. State Work Done _ 5 SOIL BORINGS NA Sealing Material & Depth 5% BENTONITE GROUT TO SURFACE Well Destruction ❑ Well Diameter Depth NA Filler Material & Depth NA TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No 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 O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. & Length of lines Total length/size FILTER BED CI Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size — Number _. SUMPS 1_1 Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby cenify 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 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 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 applicantrmaV cal�-"Il regyireq inspections. Complete drawing on reverse side Signed Application Accepted by Pit or Grout Inspection by Additional Comments: Applicant - Return all copies to �o` FEE EH 1344 IREV. I/ H s EH 11.20 Title: REGISTERED GEOLOGIST Date: 3/31/94 % FOR DEPARTMENT USE ONLY f!Ii Date Area 44 f Date Final Inspection by��t�/'j.� Date T �� San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 S�.C;c r r1 is y� �1 L C ' X [( INFO AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT NO.