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l APPLICATION FOR PERMIT r _ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PA ENVIRONMENTAL HEALTH DIVISION �� r P O BOX 2009, STOCKTON, CA 95201 r,AR 1 VE^ (209) 468-3447 SAN Q9$ PERI[I'T IRIS 1 YIsAR PROM DATE IS u ;��OgL/C rQU1NCOV rY (Complete in Triplicate) iMp/VrAL HE SERVICES Application is hereby made"to Sen Joaquin„County for a permit to construct and/or install the work herein deec i`�listr application Is maae`in compliance`"vith'San 'Joaqufn County Ordinance No. 549 and 1862 and the Rules and Regulations of.s� Joaquin County Publlc.•Health Services' - , ` F y parcel 0248-3$0-06 Job Address 28065:".5.:"...Tra i.na,Ct " 'L'ot' #6.`'' City Tracy _ Lot Size/Acreage Owner's Name William Edwards & Son Address 6352 W. Canal Blvd T Phone - 4651 Contractor Hennings Bros. Address 3525 Pe1andaIe Mod. License No. 2908 33 Phone - 1185 TYPE OF WELL/PUMP: NEW WELL)P( WELL REPLACEMENT 0 DESTRUCTION ❑ Out of Service well C1 PUMP INSTALLATION Ci SYSTEM REPAIR C1 OTHER O Monitoring-Well C3 DISTANCE TO NEAREST: SEPTIC TANK 100 SEWER"LINES DISPOSAL FLO.1.00 t PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCT_ION SPECIFICATIONS w� „- Ir n Industrial 0 Open Bottom 0 Manteca Dia, of Well Excavation Dia. of Well Casing Domestic/Private XX Gravel Pack )tX-Tracy Type of.Cosing PVC Specifications 1 An Public 1-1 Other 0 Delta Depth of Grout Seal 100-� Type of Grout M Irrigation ,.w..Approx. Depth ❑ Eastern Surface Seal Installed by Repair Work Done 0 Type of Pump H.P. State Work Done _ Well Destruction O Well Diameter Sealing Material i Depth * ” T Depth 181) _ Filler Material L Depth TYPE OF SEPTIC WORK: NEW INSTALLATION❑ REPAIR/ADOITION 0 DESTRUCTION G (No septic system permitted if public sewer is 0 available within 200 leet.1 6� Installation will serve: -Residence Commercial _,_.,. Other - (� Number of living units: Number of bedrooms "] Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Typa/Mfg Capacity No. Compartments PKG. TREATMENT PLT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line C Z l LEACHING LINE C1 No. & Length of lines Total length/size FILTER BED n Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS Ll Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this application and that the work wilt be done in accordance with San Joaquin county ordinances, state laws, and ; rules and regulations of the San Joaquin County Home ownerror 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 certifies the following: "I certify that in the performance of the worts for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of California." j The applicant must call for all required inspections. Complete drawing on revs rae side. Hennings bros. by Title: Date: 3--18-99 Signed X — FOR DEPART T USE ONLY Application Accepted by Date Area Pit or Grout Inspection by Date Final Inspection by Date 9� Additional Comments: Applicant - Return all copies to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES 445 N SAN JOAQUIN, P 0 BOX 2009, STOCKTON, CA 95201 FEE gMOUNT Dt1E AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. J�I�NPO �} UNT CASH EN 13-t�IREV.i i n�I r��r ! d `� g9,''`� 1;7fff t �/ q I— �� EM i�•2e f