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APPLICATION Ate. c pi- SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)46$-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EMIRES 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 1600 W. DURHAM FERRY R D. City TRACY Lot Size/Acreage Owner's Name GEORGE TERAN_I__SHT_ Address 1600 W. DIiRHAIN I=FRRV RISS Phone 835-3596 Contractor HENNINGS BROS. DRI E.Address 3525 PELANDALEAV_E�. _- License No, 2�0814 Phone TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT M DESTRUCTION ❑ Out of Service Well 0 PUMP INSTALLATION 0 SYSTEM REPAIR ❑ OTHER p Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 100 I SEWER LINES IQ 02 ___ _ DISPOSAL FLD. PROP, LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS C1 Industrial ❑ Open Bottom El Manteca Dia. of Well Excavation Dia. of Well Casing t' X1 Domestic/Private CX Gravel Pack )](Tracy Type of Casing_ R V C Specifications I'] Public 11 Other ❑ Delta Depth of Grout Seal 10 0 t Type of Grout B E N T G N I T F I I Irrigation Approx. Depth l I Eastern Surface Seal Installed by H E N N I N G S B R O S _ D R I L L I N G Repair Work Done U Type of Pump H.P. State Work Done_ Well Destruction O Well Diameter Sealing Material & Depth Depth 10'0 Filler Material & Depth 4 TYPE OF SEPTIC WORK; NEW INSTALLATION I I REPAIR/ADDITION { I DESTRUCTION I i INo septic system permitted if public sewer is available within 200 feet) Installation will serve: Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: ate�t t " SEPTIC TANK 0 Type/Mfg Capacity �a PKG. TREATMENT PLT. 0 t i b Distance to nearest: Well Foundation Prop*u Gne 10 1992 r - LEACHING LINE ❑ No. & Length of lines Total FILTER BED ❑ Distance to nearest: Wall Foundationff�@1i44 SEEPAGE PITS It Depth Sire Number SUMPS I_l Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state 4ndrules 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, 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. Complete8r wing on revers side. Signed X_A—LyuYlJI_N1 4 k-,LA U-aS��Tit e: Date: 8-7-92 FOR DEPARTM NT ONLY ��j� Application Accepted by Date '" 1Z Area 246 4_0 Pit or Grout Inspection by Date Final Inspection by Date �Z i Additional Comments: _ - l/O` eA-4 Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin ox 2009, Stkn, CA 95201 FEE,NFO AMOUNT DVE AMOUNT RE TT CK sf ECEIVE BY ATE PERM)-rNO.LIZ �_J/L/� ♦ EM 13.24IREv.IYX5)f!� `V V ftZ �V EM 114.26 V