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SAN ,)AQUIN COUNTY PUBLICJ Jy ENVIRONMENTAL HEALTH DMS ONRVICES 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009; STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application In hereby made to ban Joaquin County for a permit to construct and/or Install the work herein describe Thio application !e made !n ade t aSan With gen Joaquin Count Ordinance No. ct Joaquin Cowry Public Health Services. q y 9 and 1862 and the Rules and Regulars one of San JobAddrese 6649 Embarcadero Drive City StOCRtOri Lot Size/Acreage NSA owners Name Pegasus Group 1148 Alpine Road --- MitchAddress Walnut Creek CA 94596 ( 510) 930-0810 ` ell Drilling & P . O. Box 2231 Phone 1 conhacrorEnviron Corp Address Rancho Cordova CAg5741 TVPE OF W Lit 916 ) ELL/P ease Np 672617 UMP: NEW WELL Phone _ WELL REPLACEMENTFI OES TRUCTION U Out of Service Well PUMP INSTALLATION ❑ Li DISTANCE TO NEAREST: SEPTIC TANK Ll OTHER U Monitoring Well SEWER LINESYSTEM REPAIR S DISPOSAL FLO. PROP. LINE 2 ) �OUNOAtION AGRICULTURE WELL f INTENDED USE OTHEfl WELL PITS/SUMPS TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial ❑.Open Bottom U Manteca Die. of Well Excavation I Domestic/Private U Gravel Pack Dia. of Well Casing 2" 1"I Public U Tracy Type of Casinq_SC13, 40 PVC - N�n - I Other Moni for - Specifications• Slots , blk f �1�Deha Depth of Grout Seal 7=10 r �p I I Irrigation _ Approx. Depth I I Eastern Type of Grou ortland Repair Work Done U Surface Soul Installed by Type of Pump H.P. Well Destruction U Well Diameter Sealing Material L Depth bent Onate wol ee & __SLement grou Depth_ ,%Filler Material L Depth t3 Monterey sand 10-35ft TYPE OF SEPTIC WORK: NEW INSTALLATION 1 I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted it Public saws, is Installation will carve: Residenceavailable within 200 leet I Commercial_, Other Number of living units: __ Number of bedrooms Character of iol to E depth of 3 lest: SEPTIC iANkO Type/Mfg Water table depth PKG. TREATMENT PLT. U Cepacit y No. Compartments Distance to nearest: WellMethod of Disposal Foundation Property Line LEACHING LINE U No. & Length of lines FILTER BEO U Distance to nearest: WallTotal length/size Foundation Property Line SEEPAGE PITS I I Depth Sire SUMPS -- Number LI Distance to nearest: Well Foundation DISPOSAL PONDS O. Property Line I 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 Sen Joaquin County Home owner r licensed a min signature b certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any parson in sash planner ee 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 lowi of California." The epplicintt must cell for all required Inspections, Complete drawing on reverse side. W.W. I r W i n , Inc. sgnedx_�`/Cl tri/ Title: Senior Geologist June 14 , 1995 —T Date: FO DEPARTMENT USE ONLY Application Accepted by Dale Area _ Pit or Grout Inspection by Date Final inspection by Dete Additional Comments: - Applicant - Return all copies to.: San Joaquin County public llealth Services _ Environmental Be alth Permit/Services T 11 445 N San Joaquin, P 0 Rox 2009, Stkn, CA 9.5201 J D/ ' FEE AMOUNT DUE AMOUNT REMITTED INFO CASH RECEIVED 9Y DATE PERMn'NO. • FN 13 24 IREV.rrn el � EH .70 Ys/