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esti � I ...... NtL - "4 Irr atl 19F: S •' �. 1. APPLI CATION FOR :IERL I T SAN JOAQUIN COUNTY PUBLIC :LEALTH SERVICES � C. ENVIRONMENTAL UEALTU DIVISION O BOX 2008, STOCKTON, CA 95201 (209) 468-3447 1�YEAR 1?RQhd LATR (Complete in Trip)icate) r Application is heretry nadieto San Joaquin County for a yeruit to construct and/or Install the wort heroin deacriDtd- This ..........:._,. ) ' appllcatiun is made in coMpltar,ce with San Joaquin County ordinance No. 549 and 1862 and the Rules and regulations of' Lw Joaquin County PuElic Health Services. Job Address 11200 Moncure Rd. city Rlp_on ___ Lot Bite/Acreage B & B FarmsAddress 27011 Austin Rd., Ripon _ Fnone 599-4229 _ ownei s Name 8 5 Conlr+cta_ Hennings BRos. Address 3525 Pelandale, Mod. License No.-- Phone 545-11 TYPE OF WELUPUMP, NEW WELL)C( WELL REPLACEI+tE1,17 DES "UCTION C Out of Storing Vela PUMP INSTALLATION C SYSTEM REPAIR C OTHER O Monitoring Mell n .3mi. DISPOSAL FLD._— PROP. LINE CISTANCE TO NEAREST: SEPTIC TANK SEWER LINES FOUNDATION AGRICULTURE WELL OTHER W:LLl�_ PITS/SUMPS ^. INTENDjD USE TYPE OF WELL PROBI.EM AREA CONSTRUCTION SPECIFICATIONS . xtn— Cie.of Wea Ca+nq L1 Industnel D Open Bottom C Mant a DieofWel E ' Type of Cam _�tPPI Speuficalions U Domestic/Private . .Gravel Peck ❑Tracv W " n r ao onductc�. M p,IblK f7 OtM� C Oeta Depth of Grout Sea[ 5.. Type of G/OUP �J ,ir i l l y Cwnented s (IrnOuron �,L_�'ADCroa. Depth C Eastern Surface Seal Insian,.d by drl—�-- Repair Werk Dons U Type of Pump _._— H.P._ State Work Done_ t WON Cestructbn D Well Diameter Sealing Material L Depth Depth Tiller Yate*.s1 a Depth TYPE OF SEPTIC WORK: NEW INSTALLATION D AEPAISIADDIT101.Ll OL�.TRUCY :W 6 INo atb4e system pe041.1ed d pl,blic Nwer is avaitabla within 200 INt.I 1 3I InsteRation wo as": Residence_ Commercial __ Other Number of living units:_ Number of b*droorns 'Al ChMactor of Will to a depth of J feet: Water table depth k SEPTIC TANK El T}pt/Mfg Capacity No.Compartmanq f• PKG.TRE14TMENT PLT,D Method of Deposal Distance to nes,nt: Well Foundation_____ Prop*Ry Lino j. LEACHING LINE Cl No.i Length of line Total length/sirs— 1•' �A FILTER BED (-.1 Distance to nearaal: 'Nell Foundation_ _— Property Lint SEEPAGE PITS 11 Depth Sire Number SUMPS LI Distance to nearest: Well Foundation Property Line 2,. o: DISPOSAL PONDS C) I hereby cenity that I MW prepared this application and that the work will be done in accordance won San Joavuin county ordlMncea,sla,u laws,and rules and regulations of the San Joaquin County Horne owner W licensed agent's NgnCure CertilNl the IOIIOwIn g' "I certify that In the perlormanca of the wo,i for which this permit is issued,I shat)not employ any person in such manner as to become subject to workman's compensation laws of CaLforn,o."CnnlraCtOf s hiring Of Wb•COntractrng 4q M1et U1c cenlfis,the foaowing:"I certify that in the performance of the work for which this perm-1 is&sued,I&halt employ persons subject to workman'*compenas tion laws of Cefifontla," a The appkant rtxrst cera for ON regwred inspections. Complete drawing on revs( e. Hennings BRos. BY �.�- Dau: 3-6-91 Signed _ Title: FOR P MENT SE ONLY 7 Apial"lion Accepted bV �` t� - _ Dete �� Arse — Pita ouf tion dy C/S Dace Final Inspaction by_ Data _. Addit"Comments: CZ4 Applicant - Return all c ■ to: SAN JOAQJIN COI.iTY PUBLIC HEALTH SERVICES , ENVIRONkFNTAL HEALTH DIVISION PERMIT/SERVICES 445 N Sp.N JOAQUIN, P O BOX 2008, 6AU XTON, CA 65201 ,tip FEE MOUNT DUE AMOUNT REMi`T(0 CAS, I RECEIVED a DATE PERMIT N0. i'. INE 0 3 ►� .q . tv,7.24 lsay.Ir•n t�j �%Q -C'�/ I 7E1G I lI"'.A.tif� ✓�� a t � 9 �t�pri u t't m.r• r iy4iv.s4:,I�rE'at iY ,rllSr v a �`+`i"�a , j°:., ..3 s,. .�1�:5�Y,�-P��'t y��.s',;.e'h�a t��',.! 'iIR,�L��•' Y. „`,L i, �J. I 1 ,