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AppTIC,,TTON O SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES D j ENVIRONMENTAL HEALTH DIVISION L✓�,�Lai L6 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 AUG 2 6 1992 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) EWRONMENTALHEALIH Application is hereby made to San Joaquin County for a permit to construct and/or install the work ZE`ih Q§gAldd' S This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulation of San Joaquin County Public Health Services. c Job Address 13170 West Grant Line Road City Tracy Lot size/Acreage 57 —1- Owner's Name Richard Oliver Address 3600 Pruneridge, Suite 340 Phone (408) 246-5001 Santa Clara, CA 95051 Contractor Twining Laboratories Address 2527 Fresno Street License No. C57 506159 Phone 209 268-7021 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT F1 DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ p�7 Monitoring Well n DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. 1 I tS�RIOw. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing [l Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing_ Specifications 1'1 Public f'1 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx. Depth I I Eastern Surface Saul Installed by Repair Work Done U Type of Pump H.P. State Work Done_ Well Destruction ❑ Well Diameter Sealing Material & Depth Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo 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 ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Lino DISPOSAL PONDS ❑ 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: "1 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, 1 shall employ persons subject to workman's componsa- tion laws of California." The applicant must call for all require ction Complete drawing on reverse side. Signed Title: �r'°l't� '^ C� A✓' flr. OSte: FOR DEPARTMENT USE ONLY Application Accepted by �4L, Date Area Pit or Grout Inspection by Date Final Inspection by Data Z� Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services —( J 445 N San Joaquin, P 0 Box 2tkn, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED . K EO BY DA(Ti�E PZ ER �MvTlO INFO EH 3.24(FEV.1/MSIS =/79 .00 -Z 0714� 1-79-00 EH 1 � ra1C.1 /n s7nrti nGf a!� /-•tt.ln.� ./]� �1f1u�