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APPLINTIUN kli 9MIT <br /> SAN t'( U114 COUNTY PUBLIC HEALTH SEF CES <br /> ,.,aVIRONMENTAL HEALTH DIVISION <br /> 1601 E. H.AZELTON AVE. , PHONE (209)468-3420 <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> r <br /> L. <br /> 1 7 <br /> L <br /> YEAR FROM DATE ISSUED_ <br /> (Complete is Triplicate) <br /> Application is hereby made to San Joaquin County for a perialt to construct &ndjor inat theiviort-herelti,described. Is <br /> application is ma" In cowlisnce with San Joaquin county Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> joaqui.= county Public Health Services. <br /> Job Address Rough & Ready Island, NCS Stockton city Stnrkrnn Lot Size/Acreage 1400 acres <br /> Owner's Name U.S. Navv — Address Rough & Ready Island, Stockton - Phon,(209) 944-0400 <br /> 2120 Blumenfeld Dr. , California <br /> Contractor Tonto Drilling Svcs Address Sacramento, CA 95815 —License NoC5_71_584907 Phone (9 1 )646- <br /> TYPE OF WELL/P77 NEW WELL Z WELL REPLACEMENT [-, DESTRUCTION Ci out of service well Cl <br /> PUMP INSTALLATION C SYSTEM REPAIR 2 OTHEAQPT- monitoring well c <br /> 34-S�Too <br /> DISTANCE TO NEAREST: SEPTIC TANK > 50' SEWER LINES �> 50' DISPOSAL Fl_o� 50 PROP. LINE>— <br /> , <br /> FOUNDATION>_LL_ AGRICULTURE WELD LO—W OTHER WELL2LL! PITS/SUMP9i� <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> C1 Industrial 0 Open 80"OM 0 Manteca Dia. of Well Excavation Dial. of Woo Casing <br /> F1 Domestic/Private C3 Gravel Pack 0 Tracy Type of Casing Speaticaticimns <br /> I'] F4jbhc 1_1 Other X7 Delta Depth of Grout Seal 50' Type of G(oulNeat Cement <br /> I I Irrigation —Approx. Depth I I Eastern Surface Soul installed by <br /> Repair Work Done L3 Type of Pump H.P. State Work Done <br /> Well Destruction C3 Well Diameter Sealing Material i Depth <br /> Depth Filler Material i Depth fZ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system Defrinittea if public sewer is <br /> available witnin 200 feet.) <br /> Installation wall serve: Residence— Conurorctal _ Other <br /> Nurnow of living units: — Number of bedrooms I -C <br /> Character of sod to a depth of I I"ll', Water table depth <br /> SEPTIC TANK- C3 Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. 0 Method of Disposal <br /> Distance to nearest: Well Foundation _ Property Line <br /> LEACHING LINE 0 No. & Length of lines Total langtm/size <br /> FILTER BED 0 Distance to newest: Well Foundation — Property Line <br /> SEEPAGE PITS 11 Depth size Numow <br /> SUMPS LI Distance to nesirew. Woo Foundation Property Line <br /> DISPOSAL PONDS 0 <br /> I hereby certify that I how oreparea this appocation and that ins work will be done in accordance with San Joaquin county o(clinances, state laws, and <br /> rules and regulations of the San Joaquin CountT <br /> Home ovAwf of licensed agent's signature cenities me following: "I certify that in the performance of the work for which this perrrtlt is issued, I"if not <br /> employ any person in such manow as to become suciect to workman's compensation laws of California." Contractor's hiring or sub-contracting signature <br /> candies the IcHowsing: "I certify that in the performancs of the work for which this permit is issued.I shall employ persons subject to workman's compensa- <br /> tion laws of California." <br /> 'i he applicant must ca f an requWod ins Dons. Caawle <br /> Siqlnod =✓ Date: <br /> C."o-ey )"2_4 PTME "SEONLY <br /> Apol"tion Accepted by oat Area <br /> Pit or Grout Inspection b Oat@ Final Insooctilon by <br /> _JA Date <br /> 414 40, ula <br /> Additionel Comments: Val <br /> Applicant - Return all copies to: San uln colly gbllc'Health <br /> Service*, Eavironzients-L Health Permit/Services <br /> 1601 Z. Hazelton Ave., P 0 Box 2009 Stockton, CA 95201 q. <br /> FEE AMOUNT 0111 I AMOUNT REMITTED RECEIVED BY DATE NO. <br /> INFO <br /> I 6�AIS H PERMIT I !�(_, <br /> .EV. � -7, 9Y-3Z5-4-1 <br />