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. APPLICATION i a SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES � ENVIRONMENTAL HEALTH DIVISION �I 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTONj CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1 (Complete in Triplicate) Applieetioo is hereby made to San Joaquin County for a permit to construct and/or install thapplicae work herein described. This Joaquin County is Pude in cotwealthiancesery with San Joaquin County Ordinance No. 549 and 1862 and the Rulee and Regulations of San x Joaquin County Public Health services. { Job Address 85 E. LOUISE AVE.—BETWEEN HWY 5 & HARLANIt RD.LATHROP Lot size/Acreage l ARCO FACILITY fiO80 85 EAST LOUISE AVE. LATHROP 983-9140 Owner's Name Address Phone KENNINGS BROS. III Contractor Address 3525 PELANDALE, MODESTO License No. 290813 11 Phone 545-1185 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT Cl DESTRUCTION UNt of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER Cl J1 Monitoring Well L7 4 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE 1 III FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS (� f-1 Industrial ❑ Open Bottom ❑ Manteca Die. of Well Excavation Dia. of Well'Casing iI E Ci Domestic/Private ❑ Gravel Pack 0 Tracy Type of Casing_ Specifications VI Public fa Other fl Delta Depth of Grout Seal Type of Grout I I Irrigation Approx. Depth I I Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H.P, Stale Work Don Well Destruction �( Well Diameter R'r Sealing Material r1 Depth Perf r e - n t P 100, Depth t Filler Material tr Depth � t* *,( 'Ia, r` ' '7e ti TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIRlADDITION I I DESTRUCTION E I (No septic system permitted it public sewer is 1 available within 200 feet.) Installation will sere: Residence Commercial vOther Number of living units: Number of bedrooms Character of 8611 to a depth of 3 feet: Water frlbl r depth SEPTIC TANK ❑ Type/Mfg Capacity-- No. Compart"nt'i PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line li J1 i= LEACHING LINE ❑ No. 8 Length of lines Total length/size ' 1 FILTER BED ❑ Distance to nearest: Well Foundation Property Linn SEEPAGE PITS I ? Depth Size Number 11 SUMPS Ll Distance to nearest: Well 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 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, 1 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 r certifisi 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." j! j The applicant must call for All required inspections. Complete drawing o everse sid . 4 Signed x HenningS Bros. Title: Date: I� 7-29-92 a FOR EP N SE ONLY Application Accepted by ate Area I Pit or Grout Inspection by ate Final Inspection by Date', `7 Additional Comments: Applicant - Return all copies to: San Joaquin County Public Health Services j 4 Environmental Health Permit/Services �' I 445 N San Joaquin, P 0 Sox 2009, Stkn, CA 95201 /I FEE AMOUNT DUE - AMOUNT REMITTED K RECEIVED BY !� ATE PERMIT NO. „I EH 13-24 1REV,r i K 51 I ��,..�Q EH 1b2e �O J(,/ � 1 4.!`