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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PA ENVIRONMENTAL HEALTH DIVISION l;' ea 445 N SAN JOAQUIN', PHONE (209)468-3420 $E P 2 4 1992 P O BOX 2009, STOCKTON, CA 95201 SAN JoAQ(jlry C �'UBLfC H! G1 OtJl\f7`Y PERMIT R IRES I YEAR FROM DATE ISS JE OILIC, NEAU FIASE VIC (Complete ..in Triplicate) Df. 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 ccupliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 7 818 W. Se-H U L T E R D. CItV TRACY Lot Size/Acreage Owners Name PETE ALVAREZ . Address 7818 W.SCI-IULTE RD. Phone 835-1411 Contractor HENNINGS BROS. DRILLING Address 3525 PELANDALE AVE. License No. 240813 phone 545-4185 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT X1 DESTRUCTION Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 0 Monitoring Well ❑ DISTANCE TO NEAREST:-SEPTIC TANK 12.51 SEWER LINES 1_ DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 0 Industrial ❑ Open Bottom I3 Manteca pia. of Well Excavation Dia. of Well Casing 6 11 (X Domestic/Private I1 Gravel Pack A Tracy Type of Casing_ P V C Specifications I') Public 1-1 Other n Delta Depth of Grout Seal 100 t Type of Grout_-B 1=N TO N T T F I I Irrigation —,Approx. Depth I I Eastern Surface Seal Installed by H E N N I N G S' BROS. Repair Work Done U Type of Pump H,P. State Work Done Well Destruction ( Well Diameter �11 _ Sealing Material & Depth _B E N TO N T T 1=_ r Depth. • 60' Filler Material & Depth TYPE OF SEPTIC WORK: "NEW'INSTALLATION f I REPAIR,/ADDITION i I DESTRUCTION I Z INo septic system permitted if public sewer is available within 200 feet.) i Installation will serve Resid6nce ? r Commercial Other Number of living units: Number of bedrooms Character of soil'fo a depth of I feet:" Water table depth � SEPTIC TANK. O Type/Mfg Capacity No. Compartments j PKG. TREATMENT PLTtt Cl YY } Method of Disposal Distance io nearest. Well Foundation Property Line LEACHING LINE ® No. & Length of,lines Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line x 4EPAGE PITS 1 I' Depth Size Number SUMPS- Cl-.-Distance to nearest: WellFoundation Property Linea"may DISPOSAL PONDS a i I hereby certify that I.hays 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 I certifies the following: "I certify that in the performance of the work for which this permit 13 issued, I shall employ persons subject to workman's compensa- tion laws of California." The applicant must call for all required inspections. Complege draw in on re rse side. Signed X Title: Date: _ SEPT. 2 2, 1992 FOR DEPARTMEN SE ONLY Application Accepted by g' �yZ. Date Area Pit r Grout I paction by Date l a 13 �2-Fina) Inspection by Date 6 q Additions Comments: �-= jo IV -'es��ip�f-fS � e ��tt Applicanty - Return all copies to: San Joaquin County Public Health Services _ t�Td wal 4,T J y Environmental Health Permit/Services (f 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE AMOUNT DUEAMOUNT REMITTED C RECEIVED BY 7E INF SH PERMIT'NO. • EH 13.24IFIEV.IinsI Wk EH 11.2E