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J # APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE., STOCKTON, CA PAYMENT Telephone 1209) 466-6781 R r=CE I V 9D PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) MAR 1 Application is hereby made to the San J'oaqun.Local Health District 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 for sewage or No. 1862 for well/pump and tIt*"R"0jts4�m*THn Joaquin Local Health District. (� 77/Is y Czu rrp� PtkN11T ACE Job Address 34201 Mc Cracken Rd. City Vernalis Lat Size ►�1�� PM Owner's Name Al Bogetti. Address 1427 Richard Dr, Tracy- Phone 835-9120 Contractor Hennings Bros. Address 3525 Pelandale, Mod. _License No, 290813 Phone 545-1185 TYPE OF WELL/PUMP: NEW WELL X( WELL REPLACEMENT ❑ DESTRUCTION ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ DISTANCE TO NEAREST: SEPTIC TANK 1001 SEWER LINES DISPOSAL FLD. 100' PROP. LINE = FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ro ❑ Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing )o Domestic/Private X] Gravel Pack I%Tracy Type of Casing PVC Specifications Fl Public 17 Other ❑ Delta Depth of Grout Seal 180, Type of Grout ySLton 1 to I I Irrigation --Approx. Depth l I Eastern Surface Seal Installed by Clri 1 l Pr _ W Repair Work Done Ll Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 50'1 Depth Filler Material (Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION I ) REPAIR/ADDITION I I DESTRUCTION l 1 INo 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 ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. & Length of lines., Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I 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 Local Health District. 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: "t 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 required inspections. Complete drawing n eve se side. , Signed X Hennings Bros. By Title: Date: 3-30-89 ORPARTMENT USE ONLY Application Accepted by y Date ' Area Pit or Grout Inspection by Date Final Inspection by Date Additional Comments: ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 835-6385 Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE AMOUNT DUE AMOUNT REMITTED K RECEIVED BY DATE PERMIT'NO. INFOEH 13-24 + EH 14-26 1REV.I/x 5f Q ��~l ` / }'C� ► `'� r��w