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APPLICATION SAN OAQUIN COUNTY PUBLIC HEALTHSRVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EUIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby nide to San Joaquin County for a permit to construct and/or install the work herein described. his application is made in coatpliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of Sar. Joaquin County Public Health Services. Tracy [,oc size/acre a 156 .9 acres Job Address 2g900 Macarthur Drive CITY Size/Acreage Olivia Traina Estate and (408) 293-2626 Owner's Name Inan Bartle-" _ Address 1215 Camino Ramon Phone Ph P.O. Box 2231 # 6672617 9916)852-95513 Contractor Mitchell Drilling Address Rnnrhn Gordo a CA 95741 License No. on TYPE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT n DESTRUCTION O Out of Service Well O PUMP INSTALLATION O SYSTEM REPAIR O Test Hole OTHER X) Monitoring Well O DISTANCE TO NEAREST: SEPTIC TANK 50 feet SEWER LINES DISPOSAL FLD. PROP. LINE 300 feet FOUNDATION 5 feet AGRICULTURE WELL11Ol ff- OTHER WELL150 ft PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Cl Industrial O Open Bottom O Manteca Dia. of Well Excavation Dia. of Well Casing ('1 Domestic/Private Cl Gravel Pack O Tracy Type of Casing_ Specifications I'l Public 1-1 Other n Delta Depth of Grout Seal Type of Grout I I Irrigation —Approx. Depth I 1 Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done_ Weu Destruction O Well Diameter Sealing Material i Depth Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.1 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 O Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT.O Method of Disposal Distance to nearest: Well Foundation Property Lino LEACHING LINE Cl No. b Length of lines Total length/size FILTER BED O Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Sue Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS O 1 hereby conity 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 shat 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, 1 shall employ persons subject to workmen's compensa- tion laws of California." The applicant must call for all required inspections. Complete drawing on reverse side. Signed Gary D. Haeck R.G. Title: Project Geologist Date: 9-23-96 FOR PAR,TMENT USE ONLY Application Accepted by Date �� 7 l Area Pk or Grout Inspection by Date Final Inspection by Data 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 O ll FEE INFO AMOUNT OVE AMOUNT REMITTED SH RECEIVEO BY DATE PERMIT'NO. page ISA Ell 1124111Ev.1/A6) �5 � A)//7 G I EH 14.31