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.)DT.i _:1N ;OAQUIN COUNTY PUBLIC '. .ALT11 .`�AVICES ENVIRONMENTAL HEALT3 DIVISION =45 21 SAN JOAQUIN. _HONE "09)468-3420 P 0 BOX 2009, STOCBTON, (A 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �COmpleze la .:iei_-_aze) application 1s hereby made to San Joaquin County Tor a permit to construct and/or install the vorx herein described. This ippllcatlon is mae in c=dance vlth San Joaquin County Ordinance No. > 9 and 1862 and the Rules end Regulations of San "caquln County Public neaith Services. _oo Address DDRW-Tracy, 25$00 Chrisman Rd ,y Tracy _.a 61ze/Acreege 908 DDRW-Sharpe, Roth Rd. Marshall Cloud Owners Name Defense Lo istics A enc fides Lathro CA 95330 Phone (209)982-2086 �J> ��° , r/ tf 55 `tl 1 (5T77-8 o x7-8 u Contractor License No.75±22f i Phone I YPE OF WELL;PUMPNEW WELL WELL REPLACEMENT %. DESTRUCTION jfi Out of Service Well ❑ PUMP INSTALLATION 0 SYSTEM REPAIR C OTHER C Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION .AGRICULTURE WELL OTHER WELL PITS/SUMPS NTENDED USE -YPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial - Joan Bottom Manteca Dia. of Well Excavation 611-24" Dia. of Well Casing _ Domestic/Pnvate .$ 3favei Pack i$ Tracy Type of Casing Meta l_/PVC Specifications Public g Other � Delta Depth of Grout Seal Type of Grout Irrigation max.602.Approx. Depth i Eastern Surface Seal Instated by geoeu Wgrk Done _ Type of Pump H.P. State Work Done _ Well Destruction 7v') Well Diameter 2"/12-)fill Sealing Material i Depth r1acc tl Pn�mir Depth 2R-tiRn 1 Filler Material i Depth Pozmix (class H) & micromatrix TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I i DESTRUCTION I i INo septic system permitted it public wryer is available within 200 feet.) Installation will serve: Residence _ Commercial _ Other Number of living units: _ Number of bedrooms Character of sot 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 Foundation Property Line LEACHING LINE No. i Length of lines Total length/size c:_TEP BED ._. Distance to nearest: Well Founcatron Property Line SEEPAGE PITS I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS I hereby certdy 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 agents signature candies the following: "I certify that in the performance of the work for which this penikt is issued, I "If 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 candies the following: "I Centfv that in the performance of the work for which this permit is issued. I shall employ persons subject to workman's compensa- tion Ism of California." The app an must I to r qtr a ins ctionn. Complete drawing on reverse side. Signed x Title: Project HVdrO0e010gl.st Date: a FOR DEPARTMENT USE ONLY App catioonC�A.C.CC80180 by i -(/�L�OF/,�'i„N(n�,'�D Date ry l`�! ` Area Pi rout Inspection/ipn by I- ` �-tT Final Inspection by Z Dau p Additional Comments: -� 7 -i- � L!1 /i O P /(J Applicant - Return JUL copies to: San Joaquin County Public Health Services WVVL Environmental Health Permit/Services •�Q//\ 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 C7� ill i FNFO EE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO.— EN 13 24 IREV.v.eq i O