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14k APPLICATION � # D o �I SAN OAQUIN COUNTY PUBLIC HEAL H b] I ENVIRONMENTAL HEALTH DIV 90 445 N SAN JOAQUIN, PHONE (209 P 0 BOX 2009, STOCKTON, C PERMIT EXPIRES 1 YEAR FROM D (Complete in Triplica Applicatiaa is hereby made to San Joaquin County for a permit to construct and/or install the,work herein described. This application is,made in'.compliance with San Joaquin"Count di No. 549_and 1862 and the Rules and Regulations of San Joaquin county Public Health Services .l' • 'a �ijr/ ❑ WO P N Job Address S.W. CORNER/HWY 580 & PATTERSON PASS RD. City_ TRACY sag —090-28 owner's Name EUGENE SPARKS Address 26116 S. _P A T T E R S O N —PASS- U)Phone 916—,q47 t ConttacloMENNINGS BROS. DRILL ;' Address 3525 PELANDALE MOD 953561-icense No._290813 Phone 5 4 5—11 'TYPE OF WELL/PUMP: 1 NEW WELL WELL REPLACEMENT n DESTRUCTION 0 Out of Service Well4. Cl PUMP INSTALLATION 0 SYSTEM REPAIR 0 OTHER Monitoring Well DISTANCE TO NEAREST: Sfs'P,TIC TANK none SEWER LINES n011e DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS .F s INTENDED USE TYPE OF WELL. PROBLEM AREA CONSTRUCTION SPECIFICATIONS \ 0 Industrial D Open Bottom 0 Manteca Dia. of Well Excavation Dia. of Well Casing u . P V C Specifications 16 n c r h �(Domestic/Private MGravelr Pack LN Tracy Type of Casing_ E'1 Public I-1 0 h n Delta Depth of Grout Seal 1001 Type of Grout BentOnite , � I I Irrigation AE Appros. Depth I I Eastern Surface Seat Installed by_ N e it D n 1 0 5 B r o S . Drilling C1 C_Q_. `', Repair Work Done LJ Type of Pump H,P. State Work Done_ Well Destruction D WelliDiameter Sealing Material a Depth iiDepthFiller Material i,.Depth ,TYPE OF SEPTIC WORK NEW INSTALLATION I l REPAIR/ADDITION I 1 DESTRUCTION I I (No seplic-system permitted if public sewer is !_ available within 200 feet.) i, Installation will serve:. Residence— Commercial— Other � _ _—Number of living units:_ 11---Number.of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK. O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ jd Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line it SEEPAGE PITS It Depth Size Number SUMPS 0 Distance to nearest: Well Foundation -Property Line .'DISPOSAL PONDS D -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 Sari Joaquin County Home owner or licensed agent's signature certifies the following: "t certify that in the parformance of the work for which this permit is issued, I shall 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 certifies the following: "I cenify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- +tion laws of California." The applicant must catl for all r`wired inspections. Cpmplete dt�win n reverse side. ;Signed Titl —�_ 13ate: OCT. 1 1 , 1993 h FOR DEPART ENT USE ONLY Application.Accepted by Date yea C 1i Pit or tout spection by Date Final Inspection by Date Additional Comments. 11, Applicant - Return all copies to: San Joaquin County Public Health Services Q� � 1 Environmental Health Permit/ServicesJ��s 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 i d ■ AMOUNT DUE AMOUNT,REMITTED CASH RECEIVED BY DATE PERMI7'NO. 3 IN. EK 1124I11EV.t61 EK 11.20