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P 6<r ;..s lCt`d f/�w� S stems Hlad�d Cz�q) 3447-9Ylo 'ay s fiwc .aroma APPLICATION FOR PERMIT I SAN JOAQUIN LOCAL HEALTH DISTRICT { 1601 E. HAZEL T ON AVE., STOCKTON, CA PAYMENT i; Telephone (209) 466-6781 RECEIVE® PERMIT EXPIRES TYEAR FROM DATE ISSUED (Complete in Triplicate) �I` R 2 8 10M Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the v44�1ef F��d-This'<aPPlication is made in compliance with_ San Joaquin:County-Ordinance No.549 forsewage or No. 1862 for well)pm up and th R e atlbtTsbf h�'$dipJoaquin Local Health_District. 1 . .�. . . NVIRONMEN j-AL i, ,,: :-;;VISION f,' • .: .` _ _ .ill Job Address 14700 W. Schulte Rd. City Tracy Lot Size PM Owner's Name Owens—Illinois Address 14700 W. Schulte Rd. , Tracy Phone 836-$212 Ii Contractor Hen tin S BrOS.li Address 3525 Pelandale, Mod. License No, 290813 Phone `545-3185 TYPE OF WELL/PUMP: '! NEW WELL ❑ WELL REPLACEMENT DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK �}gn,,�_ SEWER LINES DISPOSAL FLD. PROP. LINE - �--- FOUNDATIOW {_AGR ICU LTURE�IIVELL =OTHE[i WELL "FIT�7 LIMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ,'(Industrial ❑ Open Bottom Ll Manteca Dia. of Well Excavation ?R" Dia. of Well Casing u 0 Domestic/Private )CXGravel'lPack Tracy Type of Casing s1:PPl r Specifications FI Public FI Other I� 171Delta Depth of Grout Seal _a dy Type of Grout I I Irrigation Approx. Depth l I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter �_ Sealing Material (top 50'1 Depth Ii Filler Material (Below 5D') -- TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION l i DESTRUCTION E I (No septic system permitted if public sewer is available withiri 200 feet.) Installation will serve: Residencell— Commercial— Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth s SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ p Method of Disposal Distance to nearest: Well Foundation Property Line �G LEACHING LINE ❑ No. &I Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line I 9 •I SEEPAGE PITS 11 Depth Size _ Number 16 - k+..—+..;G:SUMPS --- a► -L-1--Distance to nearest: -WeII— _—Foundation -_ �-Property-Line" 1 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 Local Health District. vv 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 no 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 tin 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 X Hennings Bros.;. Title. Date: 3-26-90 ii I' FOA MENT USE ONLY l Application Accepted by l; Date Area Pit or Grout Inspection by II Date Final Inspection by Date I Additional Comments: it , ❑ Stk 466-6781 0 Lod 36,9-3&1 ❑ M teca 823 04 ❑ Tracy 835-63$5 3 3-7 —35,` Applicant Return all copies to: Environmental Health Permit/Services 1601 E. Hazelt Ave., P.O. Box 2009, Stk., CA 9520 c;u4;, TV3� 356 - 386- ci IFEE NFO AMOUNT DUE AMOUNT REMITTED C H RECEIVED ly, DATE PERMIT'NO. + EH 13-24IREV.1i95) II `/5 /� Q O EH 14-26 idea i"'Oukad 240-,-Yo .s- .4Cce u�,ttc. 9SacrrC � `. 2-30 . 3.-0 c.r,-�'�- kol-pfU�