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,.IN JOAQUIN (,OUNTY PUBLIC ._EALTIi .;ERVICES a'> <br /> ,NVIRONMENTAL iEr1LT3 DIVISION <br /> -45 N SAN JOAQUIN. ?HONE ,09)468-342001, 11 2 1994 <br /> 0 BOX 3009, LiTOCKTON, 2A 95201 <br /> aERMIT FIRES 1 ENVIRONMENTAL HEALTH <br /> YEAR FROM DATE ISSUED PERMIT/SERVICES <br /> _Olnnleze 1: <br /> :.ppllcatlon is hereby made to Sen Joaquin County rcr a permit to constrict and/or install the vorx herein described. This <br /> aPpllcatlon is made 1n compissnce vith San Joaquin County Ordidance No. '-, and 1862 aha the Rules ma Regulations of San <br /> .caquln County Public health Services. <br /> -00 Address DDRW-Tracy, 25100 Chrisman Rd. �,v Tracy —1; 51ze/Acreage 908 <br /> DDRW-Sharpe, Roth Rd Marshall Cloud <br /> Owner Name Defense Logistics Agency Aadress Lathrop, CA 95330 ?hone C209)982-2086 <br /> 1202 East Kentucky Ave <br /> avractor Water Development address Woodland. CA 95695 ��cense NrC57 4 6 Phone <br /> TYPE OF WELL/PUMP NEW WELL WELL REPLACEMENT - DESTRUCTION F.! Out of Service Well 0 <br /> PUMP INSTALLATION C SYSTEM REPAIR - OTHER C Monitoring Well O <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ <br /> .VTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> :ndusln : Op <br /> ai en Bottom _ Manteca Dia. of Well Excavation 6" Dia. of Well Casing NA <br /> Dornestiu Private C Gravel Pool, Tracy Type of Casing nonip Specifications <br /> Public ]C OtherOrt]IDddAuncti Delia Depth of Grout Seal NA Type of Grout <br /> trngauon 20-40 f�APProxy. ORe7'h : Eastern Surface Soul Instaaaa by NA <br /> Redac Work Done _. Type of Pump H P. State Work Done _ <br /> Well Destruction 71 Well Diameter Sealing Material L Depth neat cpmpnt grunt -- <br /> Depth Filler Material L Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I . DESTRUCTION I No septic system permitted if public "we' is <br /> available within 200 feet.) <br /> Installation will serve: Residence _ Commercial _ Other <br /> Number of living unite _ Number of bedrooms <br /> Character of sort to a"pin Of 3 feel: Ware' table depth <br /> SEPTIC TANK C Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disoosal <br /> Distance to nearest: 'Nell Foundation Property Line <br /> LEACHING LINE No. 8 Length of lines "oral lengtn/sue <br /> °I!.TEP EED Distance to nearest: well Foundation r"ioperty Line <br /> SEEPAGE PITS I Depth Size Number <br /> SUMPS -, Distance to.nearest. Well Foundation Property Line <br /> DISPOSAL PONDS <br /> I hereby canny that I have prepared this application anlFfhat the work will be done In accordance with San Joaquin county ordinances, state laws, and <br /> rules and regulations of the San Joaquin County <br /> Home owner or licensed agent's signature certifies the following: "I certify that In the pertormance of the work for which this permit is issued, I shall not <br /> employ any person In such manner as 10 become subject t0 workman a compensation laws of California." Contractors hiring Or sub-contracting signature <br /> candles the following; A Conlfy that In the performance of the work for which this permit is issued, I shall emptily persons suplect to workman's compan". <br /> tion laws of Celit /nig." <br /> The applicant A call for all req a In cbona. omplete drawing on reverse sloe. <br /> Signed x Title: Protect Manager �C <br /> Date: <br /> FOR DEPARTMENT USE ONLY <br /> APplicat Accepted bV i Date Area / Z <br /> Pit or Grout Inspection by 114 <br /> meDale r Final Inapeenon by -a <br /> Additional Comments: <br /> Applicant - Return all copies to: San Joaquin County Public Health Services �� D / <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> INFO FEE I AMOUNT DDE ! AMOUNT REMITTED CK a RECEIVED BY <br /> i CASH DATE i PERMIT NO <br /> r <br /> '�;:: 13, 5 is 7 4w; �r�4r�<--5 <br /> til EV.11.1,1 <br />