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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) 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 compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 37437 S K O S T E R RD. City T RAC. Lot Size/Acreage Owner's Name TRINA FARMS Address 639 E . 11th St. Phone 835--6692 Contractor—HENNI &S R ROS_ DRT I_I_-Address 3525 PFIANHIF UF License No._2 g fl f 9 J Phone 1;45-1185— TYPE Of WELL/PUMP: NEW WELL WELL REPLACEMENT Cl DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR 0 OTHER ❑ Monitoring Well DISTANCE TO NEAREST: SEPTIC TANK 0.1 1 M l... SEWER LINES o.3 Mi _ DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS (Ai i 4 D Industrial ❑ Open Bottom ❑ Manteca Dia, of Well Excavation Dia. of Well Casing 14 r'X'14 ° �! fa Domestic/Private CXGravel Pack* MTracy Type of Casing_ STEEL Specifications I'I Public !-1 Other n Delta Depth of Grout Seal 100 , Type of Grout CEMENT Iw Irrigation _Approx. Depth I I Eastern Surface Seal Installed by H E N N I N G S BROS. Repair Work Done 0 Type of Pump �� H.P. State Work Done Well Destruction ❑ Well Diameter -- Sealing Material & Depth Depth .mEm Filler Material & Depth TYPE OF SEPTIC WORK: NEW INSTALLATION l I REPAIR/ADDITION I I DESTRUCTION l I (No septic system permitted if public sewer is available within 200 feet.) 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 D Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines Tota! length/size FILTER BED 0 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 will be done in accordance with San Joaquin county ordinances, state laws, an 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 certifies 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." The applicant must call for all reqaF spections. omplet drawing oV;H. e. Signed itle: Date: J U NE 29 , 1992 DEPARTMENT USE ONLY c Application Accepted by Date I ylZ Area Pit or Grout Inspection by Date Final Inspection by Date r Additional Comments: 44V, 55�' Fl-7 11 q�; C'-Ri2 -U7- Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Sox 2009, Stkn, CA 95201 FEE AMOUNT DUE AMOUNT RETED CK MITECEIVED B 9ATE PERMIT NO. INFO l . EH13.24 IREV.i i H SI75 EH 7{•Ze 11