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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC2Jy ENVIRONMENTAL HEALTH DIVISION X0 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT WIRES 1 YEAR FROM DATE ISSUEDAUG 2 8 1992 (Complete in Triplicate) ENVIRO�N��MENTAL HEALTH Application is hereby made.to San Joaquin County for a permit to construct and/or install the A p" WiRMCESbed. This application is made in compliance with San Joaquin County Ordinance No. 549 and 2862 and the Rules and Regulations of Sari Joaquin County Public Health Services. Job Address 450 East Grantline Road City Tracy Lot Size/Acreage 20 acres Owner's Name Doane Products COMPany Address d�(1 Phone 4209)835 91-1-1 Contractor Spectrm Exploration Address 2825 E. Myrtle License No C-57 5122691OnJ 209}465-8712 TYPE OF WELL/PUMP: NEW WELL 113 WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER O Monitoring Well L7 DISTANCE TO NEAREST: SEPTIC TANK 50ft. SEWER LINES 50f t. DISPOSAL FLD, 100 PROP. LINE 100 FOUNDATION 5Oft. AGRICULTURE WELL 1 rni Le OTHER WELL 4OftPITS/SUMPS 100 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom O Manteca Dia. of Well Excavation 8 in. Dia. of Well Casing 2 inch f7 Domestic/Private ❑ Gravel Pack Tracy Type of Casing_ PVC Specifications SCh 40 I'I Public F1 Other fl Delta Depth of Grout Seat 5f t. Type of Grouf:�t/EE17tonite I i Irrioation — Approx. Depth I I Eastern Surface Seat Installed by Spectr= EXploration Repair Work Done U Type of Pump n/a H.P. State Work Done _ Well Destruction O Well Diameter Sealing Material & Depth Depth Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION ( I DESTRUCTION I I Me 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 0 No. & Length of tines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS L1 Distance to nearest: Well Foundation Property Line 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: "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 lows of California." The applicant t c for all required in^Cstions. Complete drawing onressee side. Signed � f�_C�11�—� Title: l/�-C�C Date: stclr �C — FOR DEPARTMENT USE ONLY [' 2 t• Z� ST Application Accepted by Date ` �� Area d)fl} 4 Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: kftw { 5 Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 FEE INFO AMOUNT DUEAMOUNTAMOUNT REMITTED CASH RECEIVED BY DATE PERM17'NO. . EH 13-24IREV.1/N5I ��,UD gro 3 -A, g2-1',Z, q2-3 (, EH 14.20