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L U <br /> SAN JCAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> MVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420C(OPY P 0 BO% 2009, STOCKTON, CA 95201 <br /> PERMIT =!RES 1 YEAR FROM DATE T_SSUED <br /> (CompieLe in Tripiicate) <br /> application is nereby made to San Joaquin County 'cr n ?er^1t to construct andior install the work herein described_ This <br /> ipplication is mase in compliance with San Joaquin County Ordinance No. 549 arta !862 dna the Rulee and Regula.tiono of San <br /> .:.xquin -ounty Public Health Servicet. <br /> .:ob Address Dividend Development Corporation Cir, Tracy Lot SizelAcreage ApproX- 7 Arre <br /> Southern Pacific <br /> Owners Name Transportation Co. 4caress San Francisco CA Phone <br /> 11101 tdhite Rock Road <br /> Contractor McLaren/Hart -�,Jress Rancho Cordova, CA Lxense No.505932 Phone (916)638-3 6 <br /> TYPE OF WELL/PUMP� NEW WELL C WELL REPLACEMENT [7, DESTRUCTION i❑ Out of Service Well C <br /> PUMP INSTALLATION G SYSTEM REPAIR ] OTHER 0 Monitoring Well C!y <br /> DISTANCE TO NEAREST: SEPTIC TANK *71000' SEWER LINES 7 1000' DISPOSAL FLD>1QQQrPROP. LINE 20' <br /> FOUNDATION 71000 r AGRICULTURE WELL11000 t O"4a1 0-100 t PITS/SUMPS>LQOO r <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Industrtat ❑ Open Bottom Manteca Dia. of Well Excavatio lag eS Dia. of Well Casing <br /> Domestic/Private N Gravel Pack Z Tracy Type of Casing PVC Specifications SCH-4O <br /> Public ;'1 Other Delta Depth of Grout Seal 3.5-13 feet Typo of Grout cement/bento it <br /> Irrtuatton 10-ZOApprox. Depth I I Eastern Surface Seal installed bv(SregQ Drilling and Testing, <br /> Repair Work Done Type of Pump H P. State Work Done _ <br /> WeN Destrucuon ❑ Wed Oiaoter Material 4 Depth <br /> m <br /> Depth Filler Material i Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION t I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public aewor is C <br /> available within 200 feet.) <br /> Installation will serve: Residence_ Commercial_ Other <br /> Number of living units: Number of bedrooms q <br /> 1 <br /> Character of soil to a depth of 3 feet: Water tabio depth < <br /> SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments ` <br /> PKG. TREATMENT PLT. ❑ Method of Disposal C <br /> Oistanco to nearest: Well Foundation Property Lino Z <br /> LEACHING LINE C No. b Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Weil Foundation Property Lino <br /> L <br /> SEEPAGE PITS 11 Depth Size Numoer <br /> SUMPS Ll Distance to nouost: Well Foundation Property Lino <br /> DISPOSAL PONDS ❑ <br /> I hereby comfy that 1 have prepared this application and that the work will be done in accordance with San Joaquin county ordtnant:oa,stato law*,and <br /> rules and regutations of the San Joaquin County <br /> Home owner or licensed agent's signature centftes the following: "I certrfv that in the performance of the work for which this permit IS iatuod, 1 shah not <br /> employ any person to such manner as to became subject to workmen's compensation laws of California." Contractor's hiring or sutscontrocting signature <br /> certifies the foflowtng: "I carafy that to the performance of ins work for wntch this permit is issued,I shall employ poreons subject to workmcri a compcnao- <br /> tion laws of California." <br /> The appf nt must call for all required inspections. Comotete drawing on reverse side. / <br /> Signed X G Title: - tS I N (�O�( I e 7 AStato: g11!r/cj <br /> / FOR DEPARTMENT USE ONLY <br /> Application Accepted by I I Date �41 `q2-' Araa <br /> Pit or Grout inspection by ` Date Final Inspection by Data <br /> Additional Comments: >Pt<3L ' W -wa!rW-:� 6,j 4Aly�r Z <br /> Applicant - Return all copies to: San Joaquin County Public Health Services ^ <br /> Environmental Health Permit/ServiAes �� U <br /> 445 N San Joaquin, P O Box 200 , tkn, CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED H EO 8y DATE PEAMIT NO. <br /> 'INFO <br /> +En 11.24tltEv.trMiiW�! 81 (/V. I Z;1_7�� <br />