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APPLICATION 1TEI.L Mt+' — 3 OF,_3
<br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
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<br /> ENV IRONME WrAL HEALTH DIVISION
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<br /> 445 N SAN JOAQUIN, PHONE (209)468-3420
<br /> P 0 BOZ 2009, STOCKTON, CA 95201
<br /> Mai.�rEAR ROM DATE ISSUED
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<br /> (Complete in Triplicate)
<br /> P;P 6
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<br /> x t to construct and/or inn•=tt tlx work herein described. ThYs
<br /> Applicatioo in her*by aede,to sae Joaquin County for a DermY �
<br /> application is exult in ec■ ISaeee vtth Sae Joaquin County Ordinance Ko. 549 and 1862 and the Aules and Atdulstlona of San .�
<br /> y Joaquin County Pub11c Baalth Services. Y'
<br /> 8751 E. Hwy- 12 t,,,, Victor Lot Site/Acrtaae: 20 Ike. `
<br /> �; i Job Address
<br /> . .,
<br /> DoleFresh Fruit
<br /> 209 334-278n
<br /> P AAdraame
<br /> O"vw.s
<br /> NrtrM -
<br /> ry }, A.1.1 Terrain Exploration 6330 Sr.awer Road
<br /> ' #4Ari 11 Aedtess Pleas l�Cova= _ LrCense NO.1+437836 Pf+gne 44
<br /> , !tt''��,'' ? Contractor -
<br /> ^� '? ;n- �. TYPE OF WELLlPUMP: NEW WELL'❑ WELL REPLACEMENT Cl DESTRUCTION � Ba
<br /> 1 Out of rvict
<br /> OTHER u ltooitortt�Veil ,
<br /> x PUMP INSTALLATION ❑ SYSTEM REPAIR 170,
<br /> }-Ila LItSTANCE TO NEAREST: SEPTIC TANK �'p' SEWER LINES N`� D{5PO5AL PLD, NA PROP,LINE
<br /> FOUNDATION AGRIGUITURE WELLr DINER WELL T PITS/SUMPS=
<br /> g:r 4 ,.f
<br /> INTENDED USE TYPE OF WELL PROBLEM AREA
<br /> CONSTRUCTION SPECIFlCATIONS
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<br /> 0 IrtduatrrN 1 ❑Upon Bottom C3 Manteca Dis.of Will Excavation Dia,of WW Caa+tp Rm- 40 r
<br /> > , PVC Spterlietrrons
<br /> ; 1 Dor++asirelfYivatt. LGrevN Pact. l�Tracy Type of Cosin9�.
<br /> 'I'1 P.r61ie'q I:1 Other n Delta Depth of Grout Seal _„_34' - Type M G 'f
<br /> 'b `'tYst ,q s. yt 1 N� caw+ •• 40 Approx.Gepth I I E&stom - Surface Seal Ims,~by TRANS 1F "4
<br /> NA H.P. State Wak Das_
<br /> -�Rp&Work Gas 0 44 Type of Pump P r.
<br /> wol)D�rttstor Seelig Material i Depth
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<br /> w �' •r.Depth - Tiller Material a Depth -
<br /> #Js_' TYPE OF SEPTICWGAIc: NEW INSTALLATION i REPAIRIAODITION I i DESTRUCTION t 1 tNo wpuc tysrern varmated d Sewers p+bse Sea
<br /> xis ale's ':• _ 4+rai4ble wralhtn 200 IMl.1. _ e+.■
<br /> r > ,P ,Sr Irrstafhrlotr trrAp t+anre:-.Reeldence._ Canmacyt btl+a
<br /> i_r ` ;Nuntbitrol
<br /> two":
<br /> `6f
<br /> Nun+d»r M bad.00mt _
<br /> 't r Clwaear`6f maria a dopth of I hat: Wats.tabfo depth t
<br /> bmf �`fii' 'j f' .t$EPT1C TAMIL k 4 y O 'TYPN 9 Caoacrty No.Compartmer"
<br /> • , 1 tA: 3 PKQ TTnEATMENT PLT.D }AelhOd of� "
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<br /> 40"
<br /> +, 7 ENIAPnev to neatens., Well� Foruwdat�orr PtapMy lino
<br /> fi �t t REC IVED
<br /> .'
<br /> s } 3fEtLEACHING LINE,;4, ri' nts Total M+tpth/alta Of-No.i Length a!a ., -
<br /> . p "° "�`r�FILTER BEDS' rtrr LT y,0es1ana 10 rteartat:: we Foa+watron OZIBITY'
<br /> SFNV1Rf]NMFNTAI HFAL H DIVISION • `
<br /> SEEPAGE PITS I 7t Depth,
<br /> SureNumber
<br /> :t,SUMPS t !�� ';Lti Osunu to rswau: Wan '' Fqur,eat,on Property Lis
<br /> v5. 3 .i r t. .c r.St' .`^r ,""i^.r,�'c-. f=, r.�.,.,a.nL=rtMi. �:Ck 7,!, ''r•. 1 ,�-'.
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<br /> M1'• 51 Prraby drtify that I have prepared thh application and that the wak M,rn bo done rn acc«wrrca wrtlr San Joaquin coumy,orOrsneea.-sura Mrra and w F
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<br /> r rules'antl;npulsiioni of the San'Joaquin County..llI, wrt >
<br /> t 'Home owmor.Or.litenpA apant'a tliQnatlNe pMi1Nthe fompna:.,'1 esrtrty that cat the pa
<br /> rtmenco o!the■■«Y fa vsl+rch this permit k aterad;l 0.04bEa ,
<br /> !- t r.??��ernpby any pMaott in much manernas to be Omer wbfoct 10 a.orkrvwan'a compenui.on taws of Cohiory"."Comsetoes hirrlp or sub-eontracift ow-21we q, ,r��E,• i
<br /> t' r`°'' caRifimti the Ittfibwlnp cert+/V that in tM Worn,&=*of the wort Ea+vhrch Ihra paint it"ued.I ahatc 0MV40Y Persons wbpet to tearItmah's compena n,
<br /> ''„ .irek,.w,{elan lmvra o1 yCmHlarNa �» �-6.•� "• ••,.
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<br /> ,T r f16 fat"
<br /> The aPpk nt Iw aM raquo.d inspactian.Compwto 9rawawa on tava/a swtls: +' pt -'-p,
<br /> by rF v N, r TFie. a Date: TAy1 l6•�t7V. i -,Sa9er, eYEL
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<br /> .4 -S • 4 �/,`afs 'M.>aP'.•'1'[S es—C. Et Saucerm
<br /> ;��, i t �t�,r4 `" rff�.`p `�»�d�l� �?Cq� '°` - , PFOB• EPA TM VEE ONLY ���. .•
<br /> Accepted by r , l' Dau_ Area "J3 ys
<br /> ►h«wool tnmp.eibn by.,y} Darts i,nN Inspeeton by. � Dau ry
<br /> L7 I AtldltlonM t:oenn,ot+u t tiait.. ? ��? *, 's. b�
<br /> 3 yxp ''y Applicant - Returh,all copies to: sea Joaqule County Public Hrralth sarvlcee �. e
<br /> Eevirohasental Health Perait/9ervicee
<br /> 445 It Sao Joa4uln. P O 9o■ 2009, Sikh. CA 95501
<br /> ,�. '_,3 t f (� a;� '•.''^ Ifit NiO AMWNT DUE AMOUNT HEMI TED a Atcen0ED 9v - DATE' Paw No.
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<br /> �rF^c' 'r`•ra• r M ��
<br /> 'y'r *r' ��''#+` -14�,=:° T4j .h.. t
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<br /> `N st yr+ Teti
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