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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT =IRES 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 work 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. Job Address 29099 South McArthur Road City Tracy Lot Size/Acreage i Owner's Name Teichert Aggre;ateS Address 29099 S. McArthur, Tracy_ Phone Contactor Spectrum Exp. InCAddress 2825 E. Myrtle Str License No. 512268 Phone 465-8712 TYPE OF WELL/PUMP NEW WELL 'L WELL REPLACEMENT 7 DESTRUCTION AOut of Service Well ❑ RECEIVED BY PUMP INSTALLATION C SYSTEM REPAIR ❑ OTHER � Monitoring Well O DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE - TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICA 1 TUNS ItDU� C1 Industrial O Open Bottom O Manteca Dia. of Well Excavation Dia. of Well Casing n Domestic/ Private O Gravel Pack O Tracy Type of Casing_ SCL, 40 PUL Specifications It I'l Public (1 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation _ Approx. Depth I I Eastern Surface Seal Installed by OR6�su✓t C� rJlt/� Repair Work Done U Type of Pump H. P. State Work Done _ Well Destruction O Well Diameter Sealing Material L Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system fitted it public sewer is avails 1n 200 feet.) Installation will serve. Residence _ Commercial _ Other Number of living units: Number of bedrooms Character of soil to a depth o eet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments _ PKG. TREATMENT PLT. ❑ Method of Disposal _ Distance to fist: Well Foundation Property Line LEACHING LINE ❑ & Length of lines Total length/size FILTER BED Distance to nearest: Well Foundationroperty Line SEEPAGE PITO' 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line ,2IcPCSA-1 PC^!DS O -- I hereby certity that I have prepared this application and that the work will be done in accordance wiW 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 . g: "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 I of Califor ia." The olicant must all for all rgquire4 inspfli�Rion-,&mpieto drawing on reverse side. Signed Application Accepted by Pit or Grout Inspection by Additional Comments: Applicant - Return all c EH 13-24 (REV. I/ As EH 14.26 Title: Manager Date: 10-6-94 FOR DEPARTMENT USE ONLY t , Date Area J Date % f�^ Final Inspection by �` a- Date7-7 es to: San Joaquin County Public Health Services Environmental Health Permit/Services •.'.5 !1 San .Tn.t-_;lin. P 0 Box 2009, Stkn, CA 952 FEE INFO AMOUNT DUE AMOUNT REMITTED CK a CLASH RECEIVED BY ATE PERMIT ,A