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APPLICATION — SAN fOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PAYMENT 445 N SAN JOAQUIN, PHONE (209)468-3420 RECEIVED P O BOX 2009, STOCKTON, CA 95201 APR 2 6 1993 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED pSAN JOAU$�IC HEALTH COUNTY (Complete in Triplicate) ENVIRONMENTAL HEALTH Application is here made to San Joaquin Count for �jvjsj � Pp by 9 y permit to construct and/or install the work herein described. T s application is made in compliance vith San Joaquin County Ordinance No. 549 and 1862 and the Rules aad Regulations of San Joaquin County Public Health Services. Job Address 450 East Grantiine Road city Trac Lot Size/Acreage 7n aCTrPc Owner's Nam Doane Products CompantjAddress 450 East Grantline Road Phone (209) 835-9113 Contractor Spectrum Explorat:Mss 2825 E. Myrtle License NdC 57 5122(Wone (209) 465—E71 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION)1 Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 50 ft SEWER LINES 5Oft,_��DQII�SPOSAL FLD100ftPROP LINE 100 ft FOUNDATION AGRICULTURE WELL 1 Mil&HER WELL 3n ft ,PITS/SUMPS 2-" ft INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation pia. of Well Casing tr rr Cl Domestic/Private Yl Gravel Pack :2 Tracy Type of Casing_ PVC Specifications SCh 40 11 Public 1:1 Other n Delta Depth of Grout Seal 5ft Type of Grout m t/Bent on I 1 Irrigation 17Approx. Depth I I Eastern Surface Said Installed by Spectrum Exploration Repair Work Done U Type of Pump NA H.P. State Work Done_ Well Destruction OC Well Diameter 211 2 tt (1)Sealing Material i Depth Mtma f- Ciamia..TltJ-ZZ &-- Depth 17 t (3wells) Filler Material i Depth Soil (7_foot-) TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIRlADDITION I I DESTRUCTION I I {No septic system permitted it public sewer is available within 200 feet.) ' Installation will serve: Residence— Commercial_ Other a 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. 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 I I Depth Size Number �- SUMPS LI 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 cenity that in the performance of the work for which this permit is issued, E shag 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 moat call for al squired inspections. Complete drawing on reverse side. Signed X ate. Title: } Date: FOR DEPARTMENT USE ONLY Application Accepted by // Date •� ' �• Area L� _ Pit or Grout In (O• • D Inspection by Data Final Inspection by Date Additional Comments: 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 DUE AMOU�Nj�TnREMITTED CASH RECEIVED BY DATE PERMIT'NO. . EMt324IREV.iins1 �D ~� V + v6 � EN l4je