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Fes,, APPLICATION l <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUID <br /> (Complete in Triplicate) <br /> Application is hereby made to San Joaquin 'County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 5h9 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. <br /> Job Address 634 Best Rd. City Stockton . Lot Size/Acreage 20acres <br />'r Owner's Name Vince Caprini 634 Best Rd. , Stockton <br /> Address Phone 463-984$ <br /> Contractor Hennings Bros.` Address 3525 PeIandaie, hod: <br /> License No. 290$13 Phone 545-11$5 <br /> f TYPE Of WELL/PUMP: NEW WELL 0 WELL REPLACEMENT DESTRUCTION 0 Out of Service Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR C1 OTHER ❑ Monitoring Well ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK --10-0'+ SEWER LINES DISPOSAL FLD.1001_ PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> F1 Industrial ❑ Open Bottom 0 Manteca Dia. of Well Excavation611 k <br /> Dia. of Well Casing V <br /> fXDomestic/Private EX Gravel Pack7 ❑ Tracy Type of Casing_ PVC <br /> Specifications <br /> I'I Public Cl Other 11 Delta Depth of Grout Seal 100 t <br /> I I Irrigation Type of Grout Bentonite <br /> ­Approx. Depth I I Eastern Surface Seal Installed by driller <br /> Repair Work Done 'L7 Type of Pump H,P. State Work Done <br /> Well Destruction 0 Well Diameter Sealing Material & Depth y <br /> r ,; Depth Filler Material & Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION f I DESTRUCTION I 1 INo septic stem <br /> P Y permitted if public sower is <br /> Installation will #ervei Residericer`t Commercial^ 'Other '' "_` r' ."- available within 200 feet.) <br /> Number of living units: Number of bedrooms <br /> l.r. ,� <br /> Character Of=oil in s`deptOhraf,3 feet: <br /> SEPTIC TANK. abf <br /> Water te'depth 5n g` 1185 <br /> Type/Mfg <br /> PKG. TREATMENT PLT. ❑ Capacity No. Compartments <br /> Method of Disposal <br /> Distance to nearest:' Well Foundation Property Liiie' <br /> LEACHING LINE D No. & Length of lines Total length/size <br /> FILTER BED 0 Distance to nearest: Well Foundation <br /> . Property Line F <br /> SEEPAGE PITS 11' Depth Size <br /> SUMPSNumber F <br /> LI Distance to nearest: Well Foundation <br /> DISPOSAL PONDS ❑ — -- Property Line <br /> 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 <br /> rules and regulations of the San Joaquin county <br /> employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring <br /> 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 <br /> or sub-contracting signature <br /> certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall employ persons subject to workman's compen68" / <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete drawing o ' verse side, <br /> c. <br /> Signed Title: <br /> Date: _ 7-N-92 <br /> DEPA ENT USE ONLY <br /> Application Accepted by Date—3-30!a fi Area <br /> ['� I <br /> Pit 0<9aDnspection by <br /> Date ��� Final Inspection by Date <br /> Additional Comments; <br /> Applicant - Retu n al copies to: San Joaquin County Public ealth Services �fGr— — <br /> j(�f/Gr.C�(jj �py��Q Environmental Health Permit/Services' <br /> � 4 5 N San Joaquin, P O Box 2009, Stkn, CA 95201 <br /> JINFO <br /> AMOUIDUE AMOUNT REMITTED <br /> RECEIVED BY ATE PERMIT'NO. <br /> . EH 1341 IREV.FH 11.2E ��' r <br /> p <br />