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APPLICATION SAN JVAQUIN COUNTY PUBLIC HEALTH SN RVICES ENVIRONMENTAL HEALTH DIVISION 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 is hereby made to San Joaquin County for a permit to construct and/or install the vork herein described. This application is made in compliance vith San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address GRANT LINE & CORRAL HOLLOW ROADS City TRACY Lot Size/Acreage SP6 � of $36- 'f`{ )-a Owner's NameIN RHIFL ss ND- ��' Phone - �- Contractor SPECTRUM EXPLORATION,AA499- 2825 E MYRTLE ST.STOCKTQAse No. 512268 Phone 209-465-8712 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION N Out of Service Well O PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER O Monitoring Well O DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C7 Industrial O Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing n Domestic/Private O Gravel Pack YJ Tracy Type of Casing Specifications 11 Public 1.7 Other 11 Delta Depth of Grout Seal Type of Grout I I Irrigation _.Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done_ Well Destruction (N Well Diameter 2 -6 i1 Sealing Material b Depth Depth APPROX.201 Filler Material 6 Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 INo septic system permitted if public sewer is avail�sple within 200 feet.) Installation will serve: Residence_ Commercial_ Other Wv /� '� 1 �,,,1-I Number of living units: I Number of bedrooms t 1 r \ ('Dw Character of soil to a depth of 3 feet: Water table d*pth SEPTIC TANK O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.O Method of Disposal Distance to nearest: Well Foundation Property Lino LEACHING LINE Cl No. & Length of lines Total length/size 'FILTER BED O Distance to nearest: Well Foundation Property Line 0 SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Lino DISPOSAL PONDS O 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 San Joaquin County Horne owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall nota employ any person in such manner as to become subject to workmen's compensation laws of California." Contractor's hiring or sub-contracting signature- certifies ignature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ porsons subject to workman's compons� tion laws of California." The applicant mt t call for al equir inspections. Complete drawing on reverse side. REFER TO ATTACHED LETTER Sig — Title: PROJECT ENGINEER,GEOMATRIX Date:. 6/14/94 VEFP CHEF OONG, P.E. �^^ FOR DEPARTMENT USE ONLY /,,1 1� Application Accoptod by _- _ Y' l 1 Dato �!'-4 �'a 1 9 q Area v Ph or Grout Inspection by Date ( Final bApsaWn by Date s Additional Comments: l Applicant - Retur all copies to: San Joaquin County Public Health Se ices (U) OV Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201FEE O . AMOUNU/T!DUE AMOUNT REMITTED K41 RECEIVED BY AT � PRMITNO.INFO CASH Page ane 13U EH 12.IREV.Ii N DI O (z)O 66 EH 11•m