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4 .; a1zpT.IC."TTpu a 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 ROM DATE ISSUED (Complete in Triplicate) Application is hereby mach to San 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 196E and the Rules and Regulations of San Joaquin county Public Health Services. Manteca Business Center Job Address 415 Rlnrth Main ql' rPPt City Manteca ,_ Lot Size/Acreage 1„28vX1 791 c/o Flsery 2i0 491-7005 Owner's Name Resolution Trust Corp Address 171 Tnt•arpark ,61 l0�r _ _ = Phone San Antonio, TX 78216 Contractor B&F Drilling, Inc. Address 3663 Omel Circle, #8 License Ivo. C57-519428phone 916) 631-9! 46 � TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT M DESTRUCTION © Out of service Well ❑ PUMP INSTALLATION D SYSTEM REPAIR ❑ OTHER ] (Monitoring Well [3 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLU. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C] Industrial © Open Bottom (f Manteca Dia. of Weil Excavation — nch Dia. of Weil Casing n Domestic/Private C3 Gravel Pack ❑ Tracy Type of Casing Specifications ('1 Public f"1 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation —Approx. Depth I I Eastern Surface Seal installed by Repair Work Done IJ Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material & Depth Cement grout w/57. Bentonite to toga Depth Filler Material i Depth depth. TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted it 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 ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Weil Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED 0 Distance.to nearest: Well Foundation Property Line SEEPAGE PITS 1 I Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line 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 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 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 appal ant must call 0 1 req fired " spections. Complete drawing on reverse side. (Site Plan Attached) / ATEC Environmental Consultants I Signed Tile: Project Manacypr Date: DEPARTMENT USE ONLY Application Accepted by J Date a Pk or Grout Inspection by bate - Final Inspection by Date Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services N&A <<t/' Environmental Health Permit/Services ��yy 445 N San Joaquin, P O Box 2009, Stkn, CA 95201FEE INFO AMOUNT DUE OUNT RE/M�ITTED CK A CASH RECEIVED BY /DATE PEAMM NO. EM 14-26 /r