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APPLICATION FOR PERMIT .1 'AYMQNT SAN JOAQUIN LOCAL HEALTH DISTRICT RgrogIVED 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209) 466-6781 SEP Is 1989 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED F��" RONMENTA REAM O �° a (Complete in Triplicate) ApplicaW�t�AA`�\ieby made to the San Joaquin Local Health District for a permit to construct and/or install the work her In 8.'YFAsC$pp8wtion is made in com3iliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Addtess 26700 South Banta Road City Tracy Lot Size 5. 8 ac. pM Owner's Name All Pure Chemical Address Same as above Phone 209-835-5423 C57- ContractorSpectrum Explor. Address Stockton License No. 512268 Phone 209-465-87 12 TYPE OF WELL/PUMP: NEW WELL x WELL REPLACEMENT C DESTRUCTION ❑ PUMP INSTALLATLON C SYSTEM REPAIR ❑ftNone �b HER III LU . f} DISTANCE TO NEAREST: SEPTIC TANK _ SEWER LINES �� PiDIISSPOSAL FLD.270 ft . 3U—FtROP. LINE _ FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS Aa) . INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS G Industrial ❑ Open Bonom ❑ Manteca Dia. of Well Excavation LU in. Dia. of Well Casing 4 i n . ❑ Domestic/Private :1!1 Gravel Pack ISTracy Type of Casing SCH 40 PVC Specifications 1 - ft. I'! Public ❑ Other Fl Della Depth of Grout Seal Type of Grout Cem/Bent .�_ i Irrigation —Approx. Depth I I Eastern Surface Seal Installed by Spectrum Exploration Repair Work Done ❑ Type of Pump H.P. State Work Done _ p Well Destruction C Well Diameter Sealing Material Itop 501 Depth Filler Material (Below 501 Q TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION l I DESTRUCTION I I (No septic system permitted it public sewer is t� available within 200 feet.! G 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: Well Fou Property Line y LEACHING LINE ❑ No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundat Property Line -� SEEPAGE PITS 1 I Depth Size Num SUMPS L1 Distance to nearest: Well Foundation roperty 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 Local Health District. Home owner or licensed agent's signature certifies the following: "1 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."" J The applicant must call for all-raqubaO inspections. Complete drawing on reverse side. Signed X ��t .-�0�'� Title: 4 'Zt -tLCISl` Date: < y 7� i �R DEP RT ENT USE ONLY Application Accepted by Date Pit or Grout Inspection by � � Date /6",-5_1�1 Final Inspection by Date Additional Comments: C Stk 466-6781 ❑ Lodi 369-3621 C Manteca 823-7104 C Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Boz 2009, Stk., CA 95201 ",F" O AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO.