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WME�'• _ •�._ n ; 100 g._ APPLICATION FOR PERMIT SAN JOAQUIN LOCAs. HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON• CA Tetephone 12091 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED FOR MCNITCRYNG 1WELLS ICumpleze in Triplicate) Application is hereby mad•:to rhe San Jo,iou,n local Health District lar a permit to cunspuel andlor iasUll the work herein described. This application is -inaaa in carnplidnco wish San Juaclmn Lowry ouimancu no.549 tut sewn;ju ur NO. 1862 Ion wo pump dild llle rimes and Regulations of the San Joduuin Local Heallh Di5lncl. 500 EAST GRANTLINE ROAD City rPRACY Lot Sire 1 50 1X1 50' PM Job Address Owner's Name MOBIL OIL CORPORATION Address 3800 W.ALAMEDA,Si'E.700,KJRBANK Phone 818-953-2626 F 1040 URNEITrSiE.140,CONOOR462 —158 Contrac.or ALTN GEOSCI1NCE AddressLicense No. 569 TYPE OF WELLIPUMP! NEW WELL 0 WELL REPLACEMENTi i DESTRUCTION r'] PUMP INS fALLATION ❑ SYSTEM REPAIR L: OTHE:i l]1; tgC(dITtING WELLS DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES .20# DISPOSAL FLDI-MilOPRO?. LINE AW FOUNDATION 50 1 AGRICULTURE WELL Q.-5.-Mi OTHER WELL 1 L PITSISUMPS 0.5 mile ,NTENDEO USE rypE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS -. Cl Industrial CJ Open Bottom 0 Manteca Dia.of Well Excavation 10!- Dia. of Wau Casing 411 EI Domess,c/Privato IXGiavei Pacer IX Tracy Type of Casing;S�_A0 RyQ -_ Spee,fications Public I'l Other II Delta Depth at Grout Seal 71 Type of Grout NEAT f 1F1aI' I IrenJruoo - t Approx. Depth 1 t EasternSurldCe SowInsldtlad by WEST HA9t'1AT DRILLING CCMPAW -- NIRIav Work Done .i 3 Type of Pump H-P. State Work Dune - l�Ved Destnlctian :� 'Atoll Diameter Saahng Material Itop`A't Depth Fri'.ar Material lealuw W'; ,,Pg OF SEPTIC WORK: NEW INSTALLATION I I REPAii3rADDITION I I DESTR(ICTIarJ l: INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence_ Commercial— Other Number at living units: Number of bedrooms Character of soli to a depth of 3 loot: Water table depth _ i SEPTtC TANK 0 Type/Mlg _ CaPauty No. Compartments PKG.TREATMENT PLT.Q Method of Disposal Distance to nearest: Well Foundation Properly Line N/A LEACHING LINE IO No.5 Length of lines Total lengthlsize a FILTER BED CJ Distance to nearest: Well Foundation Property Line ' SEEPAGE PITS 11 Depth Sue Number N/A SUMPS 1.1 Distance to nearest: Wefl Foundation - Property Line ;..a DISPOSAL PONDS ❑ 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 rues and rogulations of the San Joaquin Local Health District. Home owner or licensed agent's signature certifies:he lollowing: "I certify that in the periormance of the work for which this permit is issued,I shall not empty any person in.such manner as fo become subject to workman's compensation laws of California."Contractor's hiving or sub eontraclrng signature - _ periniYis issued,l shall employ `sans subject to workman s cornpensa•- -- - certdies the following:"I certify That in the performance of the work far w11i�h Ibis p oy pe pc tion taws of California.-' The appy mu t Car ati required inspections.Complete drawing on reverse side. AL1gN GD0�5CIENCE PR0.1�r AGER Data: 3-1 fj-94 Signed _ Title: FOR DEPA NLY r, ' Application Accepted by Dale� �Area Pit or Grout inspection by Dataincl Inspection by Date Additional Crxnments: 0 Stk 466-6781 0 Lodi 369.3621 0 Manteca 823.7104 .0 Tracy 835 6385 Applicant-Saturn alf copies to: Environmental Health ParmillServices 1601 E. Hazolton Aefi., P.O.8a:2009, SM., CA 96MI ~ IFEE NFO AMOUNT DUE AMOUNT REMITTED RECEIVED aY DATE PERMIT NO. Ent 1344IREV.Ir.sii