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The applicant st call for all required i pections. Complete drawing on reverse side. Signed X Date: 12/0 9/94 Senior Project Manager , FOR DEPARTMENT USE ONLY Pit or Grout Inspection by Date Final Inspection by 4) Additional Comments. Applicant - Return all copies to: San Joaquin County Public Health Servic Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stkn, CA Application Accepted by Date Area 11 t)42* Date DI APPLICVT7ON 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 EXPIRES 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. 114 69 East Hammer Lane ockton Lot Size/Acreage _.,_......._ BP Oil Company 2955 W41st Street (206 251-0736 Owner's Name Address Phone Building 13, Suite N, Renton, Washington, 98005 Contractor Geo-Environmental Address P.O. Box 3595, Yuba C i tLycense No. 676923 Phone (916) 673 -14 TYPE OF WELL/PUMP: NEW WELL 0 WELL REPLACEMENT 0 DESTRUCTION CI Out of Service Well 0 Soil Borings PUMP INSTALLATION 0 SYSTEM REPAIR 08H Soi l Borg-FIR R Monitoring Well 0 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 SPECIFICATIONS 1.1 Industrial 0 Open Bottom 0 Manteca Dia. of Well Excavation Dia. of Well Casing CIDornestic/Private 0 Gravel Pack Li Tracy Type of Casing Specifications 1'1 Public IA Other IX Delta Depth of Grout Seal Type of Grout I I Irrigation Approx. Depth I I Eastern Surface Seal Installed by ____ Repair Work Done 0 Type of Pump H.P. State Work Done Well Destruction 0 Well Diameter Sealing Material & Depth Depth Filler Material & Depth Neat cement and bentoni te TYPE OF SEPTIC WORK: NEW INSTALLATION II REPAIR/ADDITION 1 I DESTRUCTION I I (No septic system permitted if public sewer is NA 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 NA 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS II Depth Size Number SUMPS NA LI 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." Contractors 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." 04 . EH 13-24 MEV. int 51 EH 14.26 FEE INFO AMOUNT DUE AMOUNT REMITTED Cictgoii RECEIVED BY DATE PERMIT NO. tri, 06 Fig,d0 ogua- 1.4,/, ah sicf V 600347