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y APPLICATION FOR PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES yw ENVIRONMENTAL HEALTH DIVISION P O BOX 20QP, STOCKTON, CA 95201 JUN 11 1991 (209) 468-3447 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 0,4VIRONMENTALHEALTH (Complete in Triplicate) PERWISFRVI.M5 Application Is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is trade 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 27383 South MacArthur Road City Tracy Lot Size/Acreage < 1 Acre Homestead Owner's Name Land Development Corp. Address P.O. Box 960, Millbrae, CA Phone (415) 692-1432 Contractor B & F Drilling Co. InQdress 663 Omec Circle (95742) License No. 519428 Phone(916)1,"-"/, TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 2( Monitoring Wellborin C7 DISTANCE TO NEAREST: SEPTIC TANK > 5OFt. SEWER LINES >50Ft• DISPOSAL FLO. >50F PROP. LINE gs) FOUNDATION -<-L0—Ft. AGRICULTURE WELL Z 50FtIDTHER WELL 5OFtPITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation 8 Dia. of Well Casing N/A IX DomesiicAP-rt-va-t-el ❑ Gravel Pack 0 Tracy(south)Type of Casing N/A Specifications N/A M Public (K Oiherborings ❑ Delta Depth of Grout Seal to surface Type of Grout cement/bent o ite M IrriOation 102Approx. Depth ❑ Eastern Surface Seal Installed by B & F Drilling Co. Inc. Repair Work Done L3 Type of Pump H.P. State Work Done _ Well Destruction O Weil Diameter Sealing Material i Depth Depth Piller Material i Depth n TYPE OF SEPTIC WORK: NEW INSTALLATION fl REPAIR/ADDITION 0 DESTRUCTION U (No septic system permitted if public sewer is Vf"` available within 200 feet.) Installation will serve: Residence — Commercial_ Other N/A rut Number of living units: Number of bedrooms Tr Character of soil to a depth of 3 feet: Water table depth W SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. O Method of Disposal (J� Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 8 Length of lines N/A Total length/size FILTER BED n Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth H/A= Size Number. SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 subcontracting 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." 1 The applica ust call for re ed inspections. Complete drawing on reverse side. Signed X Regional Manager/Engineering Date: 6/7/91 C/aures F. Frumm, R.G. FOR DEPARTMENT USE ONLY / / Application Accepted by Date `� 7 Area Pit or Grout Inspection by Date Final Inspection by Date �� Additional Comments: — Applicant — Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 95201 FEE AMOUNT DUE AMOUNT REMITTEO CK RECEIVED BY DATE PERMIT NO. INFO CASH EH 13'24 O%Ev.�rM6) ! �Z EH;�•�