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RESNR , SACRAMENTO TEL : 916-852-6638 Dec 15 ' 92 16 : 47 ND . 007 P .02 • APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SItRVICES y ENVIRONMENTAL lIEALTB DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCITON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSU]M (Complete in TriplicD.te, Application is hereby made to Sas Joaquin County for a Dernit to constniet andior -Install the work herein described. This application it aade in oopliance with San Joaqula County Ordinance No. 349 and 1862 and the Rules and Reaulatlons of San Josquia County Public Health Services. County Right of Way along Pamterson Pass Rd. Job Address near 25775, So. Patterson Pass_.RQ� city Tracy Lot Size/Acreage S,000 G^. Ft'.. Al2C0 Products Co. Adoteaa 2000 Alameda de los PulgessdP�;:02 Ownar'a Name (415) 571-245 bio 8s to I n ..��..�-__ Contractor Kv r Addreli -__, �. _cense No. ` Pnone TYPE OF WELL/PUMA: NEW WELL ❑ WELL REPLACEMENT C' DESTRUCTION ❑ Out of Service wall ❑ PUMP INSTALLATION Z SYSTEM REPAIR OTHER !Z monitoring well a DISTANCE TO NEAREST: SEPTIC TANK W _ SEWER LINES >100 ft- DISPOSAL PLD.>100 PR6P`CiN -= FOUNDATION— AGRICULTURE WELL OTHER WELL PITS/SUMPS LVA INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 7 industrial Q Oqn Bosom ❑ Manteca Dim. of wan Excavation H lrfM Du. of Was Coning d (71 Oomaaic/Ptly m, *Gravel P,aelt S, 10 Tracy Type of Casing- St. 40. PBC: - __ Specifications I'1 Putwo M Other 9 .,100 n Delta Depth of Grout Seal - 40 `t- Type of Grout rvr+rii�o/a- ; I I Irrigation ,.- Approx. Depth I I Eastern SuAaea Sad Installed IW GF24tPX Repan Work Done 0 Type of Puma H.P. Stale Work Done_ WON Destruction O WW DAmatar Sealing Ifaterial A Depth Death Piller Malarial A Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIR/ADDITION I I DESTRUCTION, ; INo $split avalem perrnaud punkt "wet is avaAabls within 200 fest.) Installation will MM: Residence Commercial_ Other Numou of laving units: — Number of bedrooms Character of fall to a depth of 3 We Water table depth SEPTIC TANK. O Type/Mi Capacity No. Compartments PKO. TREATMENT PLT.Q Method of Disposal Olstalon to nearest: Well Foundation Prowty Line LiACHINO LINE ❑ No. i Larpth of linst Total ongin/site FILTER BED Q Oistenas to nearest: WON Foundation Propem Lina SEEPAGE PITS 11 Depth Site Number SUMPS LI DivandA to nearest: Well Foundation Property Line DISPOSAL PONDS O I hereoy, ONtity that I nave prepared lhle applkaWn and that the work WIN lie 40ne in Accordance with San Joaquin county ordVlentes, state laws, and rules and regulations of the San Joaquin County Home owner or IicnnaW agent's signature certifies the following: "I corufy that in the performance of the work for which this permit is squad. I shell not employ any Orson in such martner as to become subject to workman,#compensation lewd of California." Contractor'$hking or w?COnfracfing signatuie Canities rhe foeowerlg:"I unify mat in the Wormante of the work for wn,cA:his Permit-6 sMued. : shelf.mp10Y person$10111101 to wdfkman'l compenN• tion laws of CasfWAW." The apak0ant IMI c"71r IN feq ad inagptbna. Complete growing on reverse %idJs., tar Signed Xll, ✓� � Tltu: � ro oat.: FOR DEPARTMENT USE ONLY /,P- q ?� Ap01ic1ti0n ACtapted by ' ° s � s Dau Inspection by 4-Y •�- off- /i-�- pfl a Grout I Dau Final Inagctiort by Date Adahbnal Continents; i�,�-y� �(L� � j(j C APPSiOaat , Return al;rr le✓/Co: Sae Joaqu sin llC !Nahh oervl� y©� 4451 roSannJO Rlalth Peres t3000. ens aaS N San JO►quin, P O Ana 7008, 9tkn, CA 93201 � FEE I AMOUNT DVA AMOUNT AEMITTED CASH RECEIVED aY DATE ►ARMIT'NO. INFO IN 14 a1 LJ _-