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" - SAN °'JOAQUIN COUNTY PUBLIC HEALTH -SERVICES . ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-342 =me,"I% " P O BOX 2009, STOCITON, CA 95201 ton a PERMIT EXPIRES-1 YEAR FROM DATE ISSUED u ( �� (Complete in Triplicate) 92 1 Application is hereby made to San Joaquin County for a permit to construct and/or install"�118bd3Sc �t'1: 'd' ezl'�eH"l. THis h application is made in compliance with San Joaquin County Ordinance No. 5114 and 1862 and the IRWT� wf"Sof San Joaquin County Public Health Services. I 7 a' Job Address 294 Na Drive r� City Lot Size/Acreage �plJrox. 4 _LQ3Z S 888 S. Figueroa St. Owner's Name Santa Fe PacificPipelineAdaress Los Angeles, CA 90017 Phone 213/486-7947 2825 E. Myrtle St. ' --'. Conlraclor Spectrum Exploration Address StOcktOri_ License No, 512268 Phone209/465-8712. TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n (M-2) DESTRUCTIONout of Service Weil 0 PUMP INSTALLATION. D SYSTEM REPAIR D OTHER G Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK '� SEWER LINES "'/A DISPOSAL FLD.A) A PROP. LINE `�o /n!(/ FOUNDATION 'fV/* _� AGRICULTURE WELL p OTHER WELL._ PITS/SUMPS Z« INTENDED USE :TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS L) Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Weil Casing 171 Domestic/Private 0 Gravel Pack s © Tracy 'type of Casing Specifications 11 Public 1:1 Other ` G Delta Depth of Grour'Seal Type of Grout I I Irrigation Approx. Depth - I 1 Eastern .. a Surface Soul Installed by Repair Work Done 0 Type of Pump kJ H.P. State Work Done Well Destruction ? 'Weil Diameter 4 Inch Sealing Material 8 Depth9 Fe ' Depth 26 Feet Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I i DESTRUCTION l I INo septic system permitted if public gawar is. f available within 200 feet.l Installation will serve: Residence_ Cornmercial— Other j Number of living units: Number of bedrooms e Character of soil to a depth of 3 feet: b Water labia depth SEPTIC TANK. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. o Method of Disposal Distance to nearest: Well Foundation Property Line i LEACHING LINE Cl No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line 9 S c!- SEEPAGE PITS 11 Depth f Sire 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 j 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 nSt 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." I ' The.applicanta a I uired inspections. Complete drawing on reverse side. "{ Pro ect Geologist Signed f Title: J Date: 7 1 ° 2- I FOR DEPARTMENT USE ONLY 2 Application Accepted by / ' f s Date ` Area J Pit or Grout Inspection byOt � ' a f Final Inspection b / Date? �J 1 Additional Comments: - Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Boz 2009, Stkn, CA 95201 Ut GJ•J iEE AMOUNT OtA } AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. INFO . EN 13-24MEV-" S1 -7 EH 14-20 �iuu�