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EMCON No. 939-03.,I-T/i/ APPLICATION FOR PERMIT pAk#*" NT SAN JOAQUIN LOCAL HEALTH DISTRICT JR F_C FE 1601 E. HAZE TON AVE., STOCKTON, CA Telephone (209) 466-6781 I':AY 19 8 8 PERMIT EXPIRES TYEAR FROM DATE ISSUED �RONMENTAL HEALTH (Complete in Triplicate) ENV J) ?,WTSERVICES Application is heteby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein descrited. Tis application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regulations of the San Joaquin Local Health District. Job Address rOrral Hallow Sanitary Landfill city Tracy Lot Size PM Owner's Name ounty of 1^- 1 u1n.._..___ Address _Rny 1810- !;tnrktnn, CA- Ph J2 Consultant: EM'CON Associat s 1921 Ringwood Ave. S80MOS CA. 95131 P68 275- 444 W anl:CA. —283326Phone (916)662-28'4 9 .riller s Licens C57 ntractor L:Nater—Revel Development_ Address 220 North East St TYPE OF WELL/PUMP: NEW WELL 0 WELL REPLACEMENT 0 DESTRUCTION 0 PUMP INSTALLATION 0 SYSTEM REPAIR 0 OTHER IX DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES NA --_ DISPOSAL FLD. NA PROP. LINE 25 -300' FOUNDATION RA_ AGRICULTURE WELL _NA_ OTHER WELL_!_5_!__ PITS/SUMPS NA INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS • Industrial El Open Bottom 0 Manteca Dia. of Well Excavation 10" & 211 -_ Dia. of Well Casing & • Domestic/Private N Gravel Pack W Tracy Type of Casing PVC Specifications (I Public F1 Other 11 Delta Depth of Grout Seal 250'-300' Type of Grout Vol clay, I I Irrigation _Approx. Depth I I Eastern Surface Seal Installed by Cement/Bentonite Repair Work Done L3 Type of Pump H.P. State Work Done Well Destruction 0 Well Diameter Sealing Material (top 501 Depth Filler Material (Below 501 septic system permitted if public sewer OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No s= available within 200 feet.) Installation wil Residence Commercial Other units: Number of living units: Number of bedrooms 'I Character of soil to a depth of 3 fee . er table depth O SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. El Method of Disposal Distance to nearest: Well ation Property Line LEACHING LINE El No. & Length of 1111in s �IenE th/size FILTER BED El Distance t rest: Well Foundation Pr Line SEEPAGE PITSI Depth Size Number SUMPS L1 Distance to nearest: Well Foundation— Property Line DV3F1'0_SAL PONDS E] 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 Local Health District. 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 for EMCON Associates Title: NA Date: 4/4/88 FOR DEPARTMENT USE ONLY Application Accepted by Date Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: 0 Stk 466-6781 D Lodi 369-3621 0 Manteca 1123-7104 0 Tracy 835-6385 Applicant - Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH CK RECEIVED BY DATE PERMIT'NO. + EH 13-24 IREV.1/14 51 EH 14-26