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SAN JOIN COUNTY PUBLIC HEALTH SE10CES IRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-342 P 0 BOX 2009 , STOCKTON, CA 95201 , C tza PERMIT EXPIRES 1 YEAR FROM DATE ISSIIID J U L 1 4 1982 (Complete in Triplicate) ( �I 1 ,1 ` C/1 LJ Application is hereby mede,to San Joaquin County for a permit to construct and/or instalt LYlt�a''�S��ip-k'r�h2s6-1p BtY�Td�2rt�§Cyf��yri[e�gdl�TTNls application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the t""AWT!'.K-PVfv C_.Saf San Joaquin County Public Health Services. Job Address 2947 Naw Drive City Stockton _ Lot size!Acreage j{ppl'OX 4 Acre 888 S. Figueroa St. Santa Fe Pacific PipelineAddress Los .(Angeles CA 90017 Phone 213/486-7947 Owner's Name 2825 E. Myrtle St. - Contractor Spectrum Exploration Address Stockton License No. 512268 _Phone209/465-8712; TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl (M-2j DESTRUCTION Out of Service Well L1 i Monitoring Wellotr PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER u r ..'' /(/ � DISTANCE TO NEAREST: SEPTIC TANK �_ SEWER LINES x'1A DISPOSAL FLD. //A PROP. LINE Z$0 FOUNDATION NIB AGRICULTURE WELL AL60 OTHER WELL>iOv PITS/SUMPS 1 O° INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing ❑ Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing Specifications 1'I Public ❑ Other fl Delta Depth of Grout Seal Type of Grout I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ �� 4 — Inch sealing Material i Depth v� , Well Destruction j{7 Well Diameter - Depth 26 Feet Filler Material L Depth ties L TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION 1 1 INo septic system permitted if p blc'I e +j r..- available within 200 feet.) Installation will some: Residence _ Commercial _ Other Number of living units: _ Number of bedrooms Character of soH to a depth of 3 feet: Water table depth I SEPTIC TANK. ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. b Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth 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 certity 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: '9 certity that in the performance of the work for which this permit is issued, 1311811 employ persona subject to workman's compensa- tion laws of California.)"" The applicam a o 1 r Wired inapaetiana. Complete drawing on reverse side. Signed X�a� Project Geologist Date: 11 3�y Z /.I/11 FOR DEPARTMENT USE ONLY �h Application Accepted DY �+U Date a 6 �� Area 1 1 '�� ' date /� Y Final Inspection b-'/// Data �J y Pit or Grout Inspection by Additional Commema: 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 LJ-•� FEE AMOUNT DUE AMOUNT REMITTED CK RECEIVED BY DATE PERMIT'NO. INFO CASH 4 C ^ EH q4s IREV.i/ 3p SCJ � ( 6-4 EN HM