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�- APPLICATION SA*JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES I YEAR FROM DATE ISSUED (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 is 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 450 E. Grantl.ine Road City Tracy Lot Size/Acreage 10 acres Owner's Name Doane Products Co. Address 450 E. Grantline Road Phone (209) 835-9133 {20965-8712 Contractor Spectrum Explorat>ASS 2825 E ,Myrtle,Stock.License N512268 phone TYPE. OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION DrOut of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well 76 DISTANCE TO NEAREST: SEPTIC TANK 25 t SEWER LINES 25' DISPOSAL FLD.-,n a PROP. LINE 200 FOUNDATION 25 t AGRICULTURE WELLI m] IeOTHER WELL 25 r PITS/SUMPS nj_a INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS L1 Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 2 rr Cl Domestic/Private LXGravel Pack X1 Tracy Type of Casing_ PVC Specifications SCh. 40 (') Public (.1 Other P Delta Depth of Grout Seal 5' Type of Groulcement/ I I Irrigation _,Approx. Depth i I Eastern Surface Seal Installed by Bentonite Repair Work Done L1 Type of Pump H.P. State Work Done Well Destruction i'$ Well Diameter 2 n Sealing Material & Depth Cement/Benonl e Depth 16 ' Filler Material & Depth Sand pack (16 ' ) TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION 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 ❑ 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 ❑ 1 hereby certify that 1 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 workmen'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 mu t c II fo all req .red ' tions. Complete drawing on reverse side. Signed x t5oe1 �� v '1�itle: Geologist/Brunsing Date: 1/24/92 Associates, nc. POR DEPARTMENT USE ONLY Application Accepted by AllawDate wy` �/ ' 1 Area Pit or Grout Inspection byDate Final Inspection by //I� Daate : ._ Additional Comments: Dr�e�l �� I �LCJ GciSlj r `+{w �([ _ .0>� ._ �1�I -_ Jl� �(�il.CQ(�cyw✓1 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 AMOUNT REMITTED CASyHCK � /RECEIVED BY ^ DATE gPERMgI�T'NO. . EH17-24IREV.tiK5i Dl