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' APPLICATION <br /> SANAQUIN COUNTY PUBLIC <br /> ENVIRONMENTAL HEALTH I%W <br /> 445 N SAN JOAQUIN, PHONE ( 09)468-3420 KI JOB <br /> P O BOX 2009, STOCKTON, (AI®5 01 jolo <br /> _Zu- 1171 <br /> PERMIT EXPIRES 1 YEAR FROM SSUED <br /> (Complete in Tripli ate�j �v (��ll <br /> Application is hereby msde to SJoaquin County for, a permit to construct anIN Y r e[ . is <br /> application is made in compliance <br /> liance with San Joaquin County Ordinance No. 51+L4wA-9!86@ and UTC9 ana Negulations of San <br /> ` Joaquin County Public Health Services. <br /> Job Address 10100 West Linne Road City Tracy Lot Size/Acreage <br /> ?' 4671 Firestone Blvd. <br /> Owner's Name Ameron Address Snnf•h Caf•p, CA 90380 Phone 213-564-2511 <br /> Contractor Spectrum/Kleinfelder Address 2825 E. Myrtle St License N0512268 Phone94-1345 <br /> TYPE OF WELL/PUP !', WELL REPLACEMENT {l DTSTfltX-rft7n lfr0Ut-ar,Sl=rvtt�-iP�'2r-`M <br /> ITAkPSEIRR <br /> Y TEM REPAIR 0 OTHER ' t1IMl1TtfY r4r WellTA T N A A2 test bori s <br /> Dl5 NCE 0 E � DISPOSAL FLD. PR��T� <br /> I E WELL OTHER WELL R4-T4S4400x6 21 to 15' eep <br /> INTENDED USE B CgNSTRUCTION SPECIFICATIONS Dia. <br /> C] industrial <br /> wry W- P! a r of Well Excavation - If group ate <br /> EI Domestic/Private b (-7WM ,. ,'-A He* 014j1Jloftype of Casing SpebficlaLiU.,5 encountered will <br /> i'I Public I:1 Other Cl Delta ! Depth of Grout Seal -T-Vpe-of-rtsut backfill wi h <br /> I I Irrigation Approx. Depth I I Easternff <br /> Surface Seal Installed by Hole plug <br /> Repair Work Done 0 Type of Pump H.P. State Work Done <br /> Well Destruction O Well Diameter Sealing Material & Depth O <br /> Depth Filler Material & Depth .` <br /> ( TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR JADDITION i I DESTRUCTION I I iNo septic system permitted if public sewer is ' <br /> i available within 200 feet.) O <br /> Installation will serve: Residence— Commercial Other <br /> Number of living units: Number of bedrooms_ .c <br /> Character of soil to a depth of 3 feet: k Water table depth <br /> SEPTIC TANK 0 Type/Mfg Capacity No. Compartments <br /> + PKG. TREATMENT PLT. 0 Method of Disposal <br /> Distance to nearest: Well Foundation Property Line <br /> i <br /> LEACHING LINE 0 No. S Lengtti of lines P Total length/size <br /> FILTER BED [_1 Distance to nearest: Well { Foundation Property Line <br /> r <br /> SEEPAGE PITS 11 Depth Size Number <br /> SUMPS LI Distance to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS 0 <br /> I hereby certify that I have prepared this application and that thework 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:;'4 certify that in the performance of the work for which this permit is issued, I shall not <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> certifies the following: "I certify that in t e performance of the wo'rk for which this permit is issued, I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant must c or all req r inspections. Complete drawing on reverse side. <br /> Signed Title: Regional Manager pate: 9-28-93 <br /> , <br /> OF EPARTMENT USE ONLY <br /> Application Accepted by Date >•- e:f3 <br /> Area <br /> Pit or Grout Inspection by Date i' Final Inspection b Date <br /> Additional Comments: <br /> Applicant; - Return all copies to: San Joaquin County Public Health Services <br /> '/1`Y Eavironmenta.l Health Permit/Services <br /> 445 N San -Joaquin, P O Box 2009, Stkn, CA 95201 <br /> 10Y SlFEE <br /> I <br /> 19INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY p TE PERMIT'NO. <br /> . EH -2t IPEV.+/n I1 � y/y <br /> EH 7 .26 B � r �� <br /> %4 � <br /> U ' <br /> 1 <br />