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Stilt Swoel,( COUNTY PIT13LIc UEA;,1P- !)IVISION 445 11 JN JOAQUIN , PHON]-.' 1.209)468-3420 P 0 130'X 2009 , STOCKTO.N , CA 95201 PERMIT I.XPIRES 1 YEAR FRQilS DATE ISSUED (Complete in Trlpi,,.cate) 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. 5L9 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 14900 - West Highway 12 C,1, Lodi Lot Size/Acreage 50+ acres Owner's Name Westrec Properties Add,,,, 6400 Laurel Canyon Blvd. , #200 Phone (818) 753-0400 N. Hollywood, CA 91606 mento, CA Contractor western Strata ExPl..AddreSSP-0- Box 1664, W. Sacra License No. . 552198 Phone(916) 373-11 L8 TYPE OF WELL/PUMP NEW WELL 91 WELL REPLACEMENT n DESTRUCTION 'L-) Out of Service Well L) PUMP INSTALLATION 0 SYSTEM REPAIR 'Ll OTHER 0 Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK >10 ft. SEWER LINES >5 ft- DISPOSAL FLD. N/A PROP. LINE !lee figure FOUNDATION _see f_i_q-AGRICULTURE WELL N_ZA__ OTHER WELL_.N�A PITS/SUMPS _N/A INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrial 0 Open Bottom 0 Manteca Dia. of Well Excavation 6-inch Dia. of Well Casing 2-inch RI Domestic/Private X1 Gravel Pack 0 Tracy Type of Casing Sch. 40 PVC Specifications --inglt- rAsg-d 11 Public ['I Other X1 Delta Depth of Grout Seal 4 feet Type of Grout-bent./cement I I Irrigation — Approx. Depth I I Eastern Surface Seal Installed by Western Strata Exploration Repair Work Done LJ Type of Pump N/A H.P. N/A State Work Done d 111 boxings & 5 wells Hin I te pellets Well Destruction 0 Well Diameter i IICh Sealing Material Depth 4 to 6 feet bgs with . Depth 20feet Filler Material i Depth 6 to 20 feet with clean medium sane TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I fNo 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 0 Type/Mfg Capacity— No. Compartments PKG. TREATMENT PLT. 0 Mithod of Disposal Distance to nearest: Well Foundation— Property Line LEACHING LINE 0 No. & Length of lines Total length/size FILTER BED O,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 0 I hereby certify that I have prepared this application and that the work will be done in accordance. with San Joaquin c ty ltn . a- and rules and regulations of the San Joaquin County Horne 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 sh not employ any person in such manner as to become subject to workman's compensation laws of California.— Contractor's hiring of 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 must call for all required inspections. Complete drawing on reverse side. Signed X Title: rp-Joc-d'oe— Date: 101 191S k-C,'- 4 CAS FOR DEPARTMENT USE ONLY Application Accepted by Date C J Area Pit or Grout inspection by-Vt Date Final Inspection by Date Ae� r Additional Comments: &U11 4J5 r S� Applicant - Return all copies to: San Joaquin County Public Health Services q, 0 Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009,. Stkn, CA 95201 FEE INFO AMOUNT DuE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO. 9 EN 13-24 IREV MW $89-00