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Ali-PLICATION SAN O QUIN COUNTY PUBLIC HEALTH VICES 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 work herein described. This application is made in compliance with San Joaquin County Ordinance No. 54 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address N.W. of Gr^nt TAnp & rnrral Anllnnr Rnaflscity Tracy Lot Size/Acreage 1.58 Acres 1630 Contra Costa Blvd. , Ste. 212 Owner's Name 12,8Z60 A prnpprti ec r Tnc. Address pip Ri 11. C 94523 Phon6 5 676-6677 47 Louise Street Contractor Preci ci nn gatnnl_ ngAddressSan R_af;1A1, CA 94901 License No.636387 Phone 415 456-9 75 TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well D PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHERXX Monitoring Well ❑ 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 O Manteca Dia. of Well Excavation9-2-5 Tnnh_ Dia. of Well Casing inch C7 Domestic/Private D Gravel Pack �,l Tracy Type of CasingpVt'SCH 40 Specifications ('I Public Cl Other n Delta Depth of Grout Seal 35 Saint Type of Grout ell I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by U+- �a i n c�aMpi-T n S, T^^ Repair Work Done 0 Type of Pump H.P. State Work Done _ Well Destruction O Well Diameter Sealing Material i Depth Depth Piller Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I 1 (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial_ Other Number of living units: Number of bedrooms �1 Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No. Compartment PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED D Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number (� SUMPS LI Distance to nearest: Well Foundation Property Line (� 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 Home 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 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 certify 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 mus call for al equir inspections. Complete drawing on reverse side.Refer to /work plan (attached) for details Signed Title: Project Engineer G �1 uwuacf.'1 X Date: 9 ZI q� FOR DEPARTMENT USE ONLY c Application Accepted by Date J -F6 Area Pit or Grout Inspection by Date Final Inspection ./, Date Additional Comments: p l.CJ�/'/c I f D�T Applicant - Return all cop s to: San Joaquin County Public Health Services on D Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO INFO r� q EM 13.24(REV,r/nsr 5R I�TiS! EK tt.2e �/