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_,DT.r.,, .. <br /> _,AN .;0AQUIN COUNTY PUBLIC ==LTH VICES <br /> �ZYVIRONMENTAL 11EALT3 DIVISION <br /> _45 N SAN JOAQUIN. _HONE 009)468-3420 <br /> P 0 BOX 2009, GTOCKTON. CA 95201 <br /> PERMIT =IRES 1 YEAR FROM DATE ISSUED <br /> )Complete l.. : iPi-Pate/ <br /> :,pplicatioa is nereby made to San Joaquin County for a permit to construct .and/or install the vorK herein described. This <br /> application is maae is c=:Piiance with San Joaquin County Ordinance bo. i-9 and 1862 ane the Rules arta Regulations of San <br /> .:caquin County Public eeaith Services. <br /> .:ob Address DDRW-Tracy, 25800 Chrisman Rd �,;;,y Tracy _ot Site/Acreage 908 <br /> DDRW-Sharpe, Roth Rd. Marshall Cloud <br /> Owners Name Defense Logistics A enc odes Lathrop, CA 95330 Phone (209)982-2086 <br /> w �+ �b e 55'44l I c51O y9y-8u( <br /> Contractor 5 License No.' -1 Phone 662 28. <br /> TYPE OF WELL/PUMP: NEW WELL Z WELL REPLACEMENT DESTRUCTION jf: Out of Service well Q <br /> PUMP INSTALLATION C SYSTEM REPAIR OTHER C Monitoring Well ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE <br /> FOUNDATION .AGRICULTURE WELL OTHER WELL PITS/SUMPS _ <br /> NTENDEO USE "YPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> mdusinai _ Joan Bottom _ Manteca Dia. of Well Excavation 6"-24" Dia. of Well Casing 22,3411 <br /> Domesuci Povate ,$ 3ravei Pacx !$ Tracy Type of Casing Metal/PVC Specifications <br /> - ' Public R Other M Delta Depth of Grout Seal Type of Grout <br /> ImUdtion max.60-7.Approx. Depth I : Eastern Surface Seal Ins(aoeo by <br /> Beoau Work Done Type of Pump H.P. State Work Done _ <br /> Well Destruction %] Well Diameter 2"1T 9-1 A° Sealing Material d Depth Class H Pnvmix <br /> Depth 9F-A50' Filler Material i Depth POZmix (Class H) G micromatrix <br /> TYPE OF SEPTIC WORK. NEW INSTALLATION I I REPAIR/ADDITION I : DESTRUCTION I l INo septic system permitted It public saws, is <br /> available within 200 last.) <br /> Installation writ serve: Remaence _ Commercial _ Other <br /> Number of living units: _ Number of bedrooms <br /> Character of sotl to a "pin of 3 feet: Water table depth <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. ❑ Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE No. 8 Length of lines ?oral length/size <br /> =:i TEP BED ._. Distance to nearest: Well Foundation Propeny Line <br /> SEEPAGE PITS I Depth Size Number <br /> SUMPS LI Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS <br /> I hersoy candy that I have prepared this application and that 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 candies the following: "I certify that in the performance of the work for which this permit is iasusd, I "if not <br /> employ any person in such manner as to become subject to workman's compensation laws OI California." Contractors hiring Or sub contracting signature <br /> certifies the fallowing: "I cenitv that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa• <br /> tion laws of California." <br /> The app an must I to r qu a ins actions. Complete drawing on reverse side. -71 <br /> Signed X Title: Project Hydroaeologist Date: <br /> �� FOR DEPARTMENT USE ONLY <br /> Application AA/c�cceeepted by ��-G���/����c� yl�ywyl%D Data Area <br /> Pi pr ,rout Inspection by /-� "- ate Final Inspection by � Date p <br /> Additional Comments: 14 LJOL v f-t-[ "(- f1�"y1,L� ,,¢,^i,}o, jf, QQ avLJ <br /> Applicant - Return 1 copies to: San Joaquin County Public Health Services WvtJL <br /> Environmental Health Permit/Services <br /> �Qfo <br /> 445 N San Joaquin, P O Box 2009, Stich, CA 95201 i J-� <br /> ,'FEE I AMOUNT DUE AMOUNT REMITTED CASH I RECEIVED By DATE PERMIT NO. <br /> Em <br /> 14-M y.rr.srl (fid (e o V6 <br />