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APPLICATION 00 S-2_,S7 7 SAN JOAQU1.N COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in TriplicatePate: For three monitoring wells with identical specifications 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. 1740 Houston Avenue Stockton Job Address City course Owner's Name City of Stockton Address 425 N El Doracin Si-rPPt Phone 209-937-8411 4230 Kiernan Ave., No. 105 ,PrA Modesto, CA 95356 ph on 49-545-1050 Contractor The Twining Laborat%4 License No C57506159 TYPE OF WELL/PUMP: NEW WELL /0 WELL REPLACEMENT ri DESTRUCTION El Out of Service Well 0 PUMP INSTALLATION [1 SYSTEM REPAIR Li OTHER C] Monitoring Well 01 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES 1,800' E DISPOSAL FLO:0019AI PROP. LINE1110 i S FOUNDATION 210 1 AGRICULTURE WELL>2,000 I W OTHER WELL81:10 1 f:E PITS/SUMPSY (lagca- INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 1.1 Industrial 0 Open Bottom 0 Manteca Dia. of Well Excavation 8-111± Dia. of Well Casing 2-inch CI Domestic/Private a Gravel Pack 0 Tracy Type of Casingailadlia20_12C___ Specifications2—InCh 1'1 Public Cl Other X1 Delta Depth of Grout Seal 6 1 Type of Grozz16—Eaek—Mrli 4146 1 I Irrigation V_ Approx. Depth I I Eastern Surface Seal Installed by Mainirrj ri=m=rii- WI-% 1-1=t-rtnrii-e Repair Work Done LI Type of Pump n/a. H.P. n/a State Work DoneLlEtalliapnalithriug_Nnell Well Destruction 0 Well Diameter 2-tryti Sealing Material & Depth Bartrni.th pellertS flan 6_9' Depth 30 Filler Material & Depth sand pair& slurry w criite film 2-6' _feet TYPE OF SEPTIC WORK NEW INSTALLATION 1 1 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 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth Size Number SUMPS L I Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 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 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 applicant must call for all requ ed inspections Complete drawing on averse side. Title: rojerf .e.1210//57" R DEPARTMENT USE ONLY Application Accepted by 5 /I i D ate ,1 Area 2 * 'l 7 Pit or Grout Inspection by Date Final Inspection by Date C c&fT-fr/rn Additional Comments: 36 7 Lot Size/Acreage170.8 acre golf Signed X Date ‘'477ji EH 13-24 (REV. i EH 14-25 Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services f-c- I 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE INFO tilin AMOUNT DUE AMOUNT REMITTED RECEIVED --1,eir-21-1 BY DATE PERMIT NO >#' calek V i — sir c de CI / — e•oi& <i-ci -ci/Vyy ao3 6 g7 c'\