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F = (� APPLICATION FOR PERMIT ` SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE {209}468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FR9M DATE LaSUED (Complete in Triplicate) Application is here made to San Joaquin Count for App by Q y permit to construct and/or install the work hereiri described. This application is made in 0cuplienee with San Joaquin County Ordinance -No. 549 and 1862 and the Rules and Regulations of San Joaquin'Cot�ty Public Health Services. Job Address 26003 Corral Hollow Rd. City Tracy Lot Size/Acreage 353'x1051 - Owner•sName Kridly Inc./Charles BondAddress 26003-Corral Hollow, Tracy Phone 836-9054 Contractor, Hennings Bros: Address 3525 Pelandale, Mod. License No. 290813 Phone 545-1185 f TYPE OF WELL/PUMP: MEW WELD WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C7 DISTANCE TO NEAREST: SEPTIC TANK 1201 SEWER LINES DISPOSAL FLO. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS 5Q! INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS L1 industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing 611 XXDomestic/Private XX Gravel Pack IM Tracy Type of Casing_ PVC pecilications 160 11 Public �.�1-/1 Other , . Cl Delta Depth of Grout Seal -- 1�i� Type of Grout $�� On 1�L (t�/ I I Irrigation ;a+XApprox. Depth I I Eastern Surface Seal Installed by 0 l PY h Repair Work Done 0 Type of Pump H.P. State Work Done , Well Destruction ❑ Well Diameter Sealing Material i Depth ,AT)n Depth, tiller Material i Depth r O TYPE OF SEPTIC WORK: NEW INSTALLATION [ I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sower is �. available within 200 feet.I ; r Installation will i4i":' Residence_ Commercial Other . fi 1 t1 Number of living units: Number of bedrooms Character of$ON to a depth of$ feet:' Water table depth SEPTIC TANK. 0 Type/Mfg Capacity No. Compenments PKG. TREATMENT PLT.❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE C1 No. & Length of lines Total length/size FILTER BED ❑ Distance to nearest. Well Foundation Property Line (� SEEPAGE PITS 11 Depth Sire Number SUMPS LI 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 Inspgctions. Complete drawing on reverse side. Signed X _Hennings Bros. Dr-i l l ing Co. ,Inc-Title: B � Date: 2-1-93 OR DEPARTMENT SE ONLY r Application Accepted by Date U. �� Area Pit rout I Ion by __/ Date LL Final Inspection by / Date Additional Comments: :��Q� f � gee: gyp" ��,f j .o �- / I ty A a i D Applicant - Return all copies to: Ban Joaquin.County Public Health Services Environmental Health Permit/Services �F� 'P 445 N San Joaquin, P O Box 2009, Stka, CA 95201 INFO AMOUNT DUE /AMOUNT REMITTED CK RECEIVED BY D�jTE PERMIT-NO. r « EH 14•24 irlt'V.i/x 57 tiH 1 .26 O '