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APPLICATION f SAN JbwQUIN COUNTY PUBLIC HEALTH S"A#6— ENVIRONMENTAL ENVIRONMENTAL HEALTH D I V I S I;ON (� } 445 N SAN JOAQUIN, PHONE (209)468=P2Q - P 0 BOX 2009, STOCKTON, CA 952D,l I 1 PERMIT EXPIRES 1 YEAR FROM DATE ISSUI� (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 1a made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address N.W. OF GRANT LINE & CORRAL HOLLOW ROADSti,, TRACY Lot Size/Acreage 1.58 ACRESTA �r �==!6�ress a ,, X23 7 Owner's-Nme P ne 2825 E. MYRTLE ST. Contractor SPECTRUM EXPLORATION, Addresi STOCKTON, CA 95205 License No. 512268 Phone 209-465-871 TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT M DESTRUCTION O Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ 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 CI Industrial ❑ Open BottomG Manteca Dia. of Well Excavation Dia. of Well Casing 4., * Domestic/Private O Gravel Pack M Tracy Type of Casin PVC S H. Specifications pecifications f'I Public 71 Other n Delta Depth of Grout Seal APPROX. — Type of Grout VOLCLAY I I Irrigation _Approx. Depth I I Eastern Surface Soul Installed by SPECTRUM EXPLORATION INC. Repair Work Done U Type of Pump H.P. State Work Done Well Destruction O Well Diameter Seal=a8 Material i Depth Depth Filler Material Z Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADOITION I I DESTRUCTION I I (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 Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK O Type/Mfg Capacity No, t nts 411 7- PKG. TREATMENT PLT. O Megm f- P3- Distance to nearest: Well Foundation Property In �+I r LEACHING LINE ❑ No. 8 Length of lines Total len (; 1�. 4 FILTER BED O Distance to nearest: Well Founaation IElbPMq Li4,"L,""C o/!,n�T f'E 0E1>'y!r c SEEPAGE PITS I I Depth Size Number h�!1/l SiFtpJ SUMPS . LI Distance to nearest: Wall Foundation Property Line ' �\ DISPOSAL PONDS ❑ I hereby certify that I have prepared this appiication 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, Ishall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or subcontracting 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." REFER TO WORK PLAN EXCERPTS (ATTACHED) The applicant mus 11 for all requ" ins ctions. Complete drawing on reverse side.FOR DETAILS. Signed Title. PROJECT ENGINEER,GEOMATRIX Data: 8/ VEEI`j H" EEn FOONG P.E. p[� F( r EP '�� EN Off? / 7 Application Accepted by LIAp Pit or Grout Inspection by Date .Final Inspection b 7i �S Y pate Additional Comments: LI-) 13 /1:5 Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services rr/) 445 N San Joaquin, P 0 Box 2009, S tkn, CA 95201 L v{l U INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. 'M lyaj :M 14.20