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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION (/V 445 N SAN JOAQUIN, PHONE (209)468-3420 ,l P 0 BOX 2009, STOCKTON, CA 95201 �Nv J1S2— 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 described. 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 30350 South Tracy Blvd . , City Tracy Lot Size/Acreage 94566 Owner's Name RMC Lonestar Address P.O. BOX-5252 Pleasanton Phone 510-426-2279 Commerce City 51 boil 303- Contractor Becker Drills Address POB 567, CO 80037 License No.( -574A*T Phone 2 86-7776 OF WELL/PUMP NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well O PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ SPilri OTHER�C monitoring WellBorl DISTANCE TO NEAREST: SEPTIC TANK NZA SEWER LINES N/A DISPOSAL FLDgN A PROP. LINE 1000 FOUNDATION N/A AGRICULTURE WELL N A OTHER or 1 n9 ;ITS/SUMPS UZ—A INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Industrial ❑ Open Bottom O Manteca Dia. ofXWIxExcavation 8" Dia. of Well Casing N/A f I Domestic/Private ❑ Gravel Pack r Tracy Type of Casing___ N/A Specifications N/A i'! Public IXOtherBOrings 1-1 Delta Depth of Grout Seal FU 11 Depth Type of GroutNeat Cement (W I i Irrigation 1 OQ_' Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H.P. __ State Work Done Well Destruction ❑ Well Diameter Sealing Material i Depth ( {� Depth Filler Material i Depth YM NT �Jl TYPE OF SEPTIC WORK NEW INSTALLATION i 1 REPAIR/ADDITION I I DESTRUCTION I I INo septics Wilblic sewer is available wit i feet.) Installation will serve: �ne,cml._ Other ! " 'Number of living units: N1rtli\TlrCharacter of soil to a depth oW o AN JOAtJ.)i 1'a Y 9� CES \ � SEPTIC TANK O Type/Mfg Cspac' Et1NJIQ@W6jjjoiiiu iLALT H DIVISI PKG. TREATMENT PLT. ❑ Method of Disposal \ Distance to nearest: Well Foundation Property Line LEACHING LINE Cl No. 8 Length of li _ Total length/size O FILTER BED ❑ Distance to rest: Well Founaatron Property Line SEEPAGE PITS 1 1 pth Size _ Number SUMPS Distance to nearest: Well _ Foundation Property Line DISPOSAL PONDS ❑ I 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 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: Agent for Owner Data: 12/29/93 F PARTMENT USE ONLY Application Accepted by � � Oate qq Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: A plicant - 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 INFO AMOUNT DUE AMOUNT REMITTED C K H RECEIVED BY DATE PERMIT NOEH 13-24 . EN 14-20 0 , Vb L3Y+: O� -- ✓' 1 2 0( (ln6