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m 1 <br /> + W <br /> { <br /> AII,I(AtI ON Foil <br /> t hit <br /> ►I IT <br /> SAN JOAQUIN COUNTY PUBLIC REAL'1'II SERVICES <br /> ENVIRONMENTAL ,HEALTII ll1VISION <br /> {� 1601. E. IIAZEI,TON AVE. , PHONE J(209)468-3420 <br /> Int P O BUR 2009,'� STOCg'1'ON , I;CA 95201 <br /> PERMI;l, EXPIRES 1 YBAI2 FROM. IiI)A'1'E—���1F1) <br /> (Complete in Triplicate) . <br /> n{•{,11,•ntlon is hereby made to San Joaquin County fora permit to construct land/or install the work herein describr_d. '1'Lir: <br /> Application 1e made in conipliance with San Joaquin County Ordinance No. 5119: and 1862 and the Rules and Regulations of San <br /> JoAquin County Public Health Services. <br /> -' �..I, Address � - - �Z1GE[ city <br /> Name Address <S'3%�� fU�i0/= G_'. ' �_� -- Phone (_�&S_-5i <br /> I Nostern Strata Exploration P.O. Boxl:66 <br /> c,lraclor "._ _ Address West_Saeramen to,Ca. License No. 552198 Phorie 173V111=$__-. <br /> 4� T`rPE OF WELL/PUMP: NEW WELL n WELL REPLACEMENT 11, DESTRUCTION ❑ Out of Service Wei 1 L? <br /> PUMP INSTALLATION O SYSTEM REPAIR ❑1' OjyER (►� Monitoring Well (� l <br /> I'IS I A NCE TO NEAREST: SEPTIC TANK % // <br /> �. SEWER LINES _ 3." _fT_ DISPOSAL FLO. -��/-�- PROP. LINE S�E�i��,e� <br /> DATION U <br /> FONF�a;d[E 1'_ ( '' - � <br /> _ SSE AGRICULTURE WELL _1_+iT_OTHER WELLs <br /> .--L �_ PITS/SUMPS <br /> r' <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS f <br /> 4j Industrial Ll Open Bottom (.) Manteca Dia. of Well Excavation t' <br /> _ Dia: of Well Casing <br /> itnnlestic/Private l l Gravel Pack I"I Tracy 11 <br /> Type of Casiny_" _...__'i 5pecilications-__— <br /> yI Public I T OU,er L <br /> I I Delta Depth of Grout Seal 20 fT Type of <br /> In q):rrinn 7ofApprox. Depth I I Easurcrt Surface Seal Installed by <br /> 'j RPpab Wak Done (_T Type of Pump N.¢ N.P. /Y - ---- - -----__.. <br /> - -- _! one T _-.Soe/.✓�6S- Sr>'T)- <br /> Destnrction ❑ Well Diameter _.b Sealing Material 6 Depth !I State Work D <br /> ii Depth __069 Filler Filler Material 6 Depth 11.---_ <br /> j' 1 rl'f. OF SEPTIC WORK: NEW INSTALlAT1ON 11 REPAIRIADDITION I I DESTRUCTION I I iNo septic system permitted it public sewer is _ <br /> available within 2()0 feet.) i <br /> dt .._••:� - will sAry^„ e: Rusrdence Commercial Od er <br /> E <br /> LAW ENVIRONMENTAL, INC." WELLS FARGO BANK <br /> 000(-'ivic Cewel.Ilrive 600LAS <br /> RAFEI C <br /> as c nu-INAS qve Nuk <br /> SAAq 490311-2 <br /> 4x53) <br /> Suile 305 9 <br /> X2649 i't7o�a) <br /> Salt IZa}act,CA949()3-41.52 41, <br /> . May 21, 1991 ' <br /> S.. PAY <br /> It DOt l,gFiS AND - <br /> 00 CENTS <br /> b <br /> 0 THE <br /> RDERSAN JOA UI COC <br /> R N Cj PUBLIC HEALTH <br /> F <br /> P O. Box 1009 <br /> STOCK:TON CA,95201 <br /> f1 00 2649ffo L 2x,000 2J. <br /> A.4 <br /> i <br /> ii <br /> Al%plir.alion Accepted by <br /> I',t cr Grout Inspection by <br /> ------------_..--__--._ DataFinal Inspection i"by___._-- [)ate <br /> 1rNonal Comments: <br /> 'sl''llcnnt - Return all. copies to: So.n Joaquin County Public Health { <br /> Services, Fnvironme_ntal Ilea]th Permit/Servi'ices <br /> 1601 E. Hazelton Ave., P 0 Box 2009 Stocklton CA 95201 <br /> --FEE--j­A�0titlT <br /> OtIE AA10UtlTRFMIfIFDCK �INFO CASH RECEIVED BY DATE PERtAIT NO <br /> --- - _ <br />