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"" TA APPLICATION �� 93-ao�rs SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DI 445 N SAN JOAQUIN, PHONE (20 )08—.;142Q 1 18 6 P 0 BOX 2009, STOCKTON, C 95201 —U.v—l121IEap_ p� PERMIT E RDA[ , q G0 �31 (Complete in Triplic ¢)f,,.. it Application is hereby mads,to San Joaquin County for a permit to construct d/or lneta e 1 application in made is compliance with San Joaquin County Ordinance No. 549 nd(l68( pd t e B sand Regulations of $an Joaquin County Public Health Services. 11�� . Off/ Job Address 12920 BYRON HWY Ciry TRACY- l,ot Size/Acreage Owner's Name ANNE G. STELLE Address L �12920 BYRON HWY TRACY CA Phone 835-7276 _ .^ Contractor HENNINGS BRQ5- DR]L Address 3525 � A_L NDALF, 0�5fi License No.290A 1 3 Phone -1 1AS- TYPE OF WELL/PUMP: NEW WELL D WELL REPLACEMENT n DESTRUCTION}(-J(Out of Service Well 0 PUMP INSTALLATION ❑ SYSTEM REPAIR n OTHER �] 14onitoring Well ❑ DISTANCE TO NEAREST; SEPTIC TANK 140 SEWER LINES 1 40_1 + DISPOSAL FLD. PROP. LINE �\ FOUNDATION AGRICULTURE WELL __ OTHER WELL PITS/SUMPS v INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom 0 Manteca Dia. of Well Excavation 12 11 Dia. of Well Casing 6 11 Domestic/Private l7l Gravel Pack I(1 Tracy Type of Casing_P It C Specifications OS r h I Pubtk (71 Other n Delta Depth of Grout Sear 100 1 Type of Grout Bent QnitP I i Irtivation ^ Approx. Depth I i Eastern Surface Saul Installed by HN N IN` Repair Work Done U Type of Pump H.P. State Work Done Well Destruction ]X Well Diameter 6" Sealing Material A Depth HO I e P I u Depth 50-60 ' A jzr n x , Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION 1 I REPAIR!ADDITION I I DESTRUCTION I I INo septic system permitted it public sewer is available within 200 fart.) Installation will serve: Residence_ Commercial_ Other Numbar of living units: Number of bedrooms Character of sag to a depth of 3 feet: Water table depth SEPTIC TANK D Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Welt Foundation Property Line LEACHING LINE ❑ No. b Length of lines Total length/sizer, FILTER BED n Distance to nearest: Well Founoation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONOS ❑ I hereby cartity that I have prepared this application and that the work will be done in accordance with Spin 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 petformence of'the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to workmen's compensation laws of California," Contractor's hiring or sub-contracting signature J�prtifies the following:"I certify that in the performance of the work for which this permit is issued, I sl+all employ persons subject to workmen's compensa tion Lowe of Californla.- The applicant must call for all required inspections. Compl a drawing on reverse sid a � Signedv Data: OCT. 8 , 1993 FOR�EiEPAAAENT USE ONLY Application Accepted by L Date ha Area Plt or Grout Inspection by Date Final Inspection by Date � I Additional Comments: Applicant - Return a 1 copies to: Ban Joa uin County Public Health Services �RogQ $nvironmental Health Permit/Services 445 N Sao .Joaquin, P O Box 2009, Stkn, CA 95201 t� FEE 1 AMOUNT OUE AMOUNT REMITTED C H RECEIVED BY D TE JPERMIT NO. INFO �£N t�IE�+.,,.,t COD EH 14.20