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:IYYL 1 l.�l l'1 UN SAN IQUIN COUNTY PUBLIC HEALTH AVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 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 aescribed. 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 413 Mt. Diablo Ave. (Old Valley, Mile c,ty Tracy Lot Size/Acreage 3.04 Post 215 site) 4000 Executive Parkway, Bishop Ranch No. 8 owner's Name Chevron Pipe I inP AddressSan Ramon CA 94583-0959 Phone (510)842-6855 - lh L)aM tt) C MPD BaX i Cs��nt� Sotf Contractorc-F PIFI A ress �►'O�tfi11`0 License No. -- Phone (916) NEW WELL C WELL REPLACEMENT F, DESTRUCTION O Out of Service Well C r I S PUMP INSTALLATION C SYSTEM REPAIR C OTHER �( Monitoring well ❑ �pp�t^ DISTANCE TON REST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PRC?"LfN�be 1 S'p�( ori%.--e FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED 6SE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS i� Industrial O Open tom u Manteca D a. of Well Excavation Dia. of Well Casing XX Domestic/Private O Gra Pack IN Tracy Type of Casing__ Specifications FI Public Cl "er Fl Delta Depth of Grout Seal Type of Grout i i Irrigation Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done U Type of Pump H.P. State Work Done _CA Well Destruction ❑ Well Diameter sp-' Sealing Material i Depth r Pm P n t./hP n t.n n i t gJO U t Depth 211' to 75' Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION i i REPAIR/ADDITION DESTRUCTION I i INo septic system permitted d public sower 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. C Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 8 Length of lines Total length/size FILTER BED n Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS C 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 permits issued, I shall employ persons subject to workman's compensa- tion laws of California." The applicant must call for all required inspections. Complete drawing on reverse side. Signed X Z(4 1A i r?� Title: C%-010QlSf Date: FOR DEPARTMENT USE ONLY �s y Application Accepted byDate Area Pit or Grout Inspection by Data -5 Final Inspection by Date 9�� 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 CK INFO AMOUN�TJ DUE AMOUNT REMITTED CASH RECEIVED By DATE PERMIT NO. Page 13AEM t4-21111Ev.liner X U� �?� 7 � �j / �51 EH t1.2a U ✓ / - - /