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77 <br /> ATION FUR-.PERM-IT <br /> 40 APPLIC <br /> SAN JOAQUIN COUNTY PUBLIC "HEALTH_. SERVICES �d I <br /> ",ENVIRONMENTAL +HEALTH DI-VISION <br /> P O BOX 2009, STOC$TON, CA--95201 <br /> (209) 468-3447 - <br /> PERMIT -A2 BAR NM DA19 ssma <br /> (Complete in Triplicate) <br /> Application is hereby made,to San Joaquin County for a permit to construct and/or install the work berein.described. This- <br /> application is made in .compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and'Regulationa of San E <br /> Joaquin County Public Health Services. ✓ <br /> Job Address <br /> 20650 N. Elliott Rd. City LOCkef r Lot Size/Acreage <br /> FOwner's Name B & P Farms Address _5000 E Fremont. Stor.kton Phone .� - <br /> Conlractor <br /> Hennings Bros. Address 3525 Pelandale, Mod. License No: 290813 Phone 545-1185"'` <br /> TYPE OF WELL/PUMP: NEW WELLU WELL REPLACEMENT n DESTRUCTION Cl out of Service well C) <br /> PUMP INSTALLATION Q SYSTEM REPAIR Cl OTHER O Monitoring well <br /> DISTANCE TO NEAREST: SEPTIC TANK — 50O t f SEWER LINES DISPOSAL FLD, PROP, LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL1;Q01 _ PITS/SUMPS' <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECtFICATIONS tr <br /> fl Industrial ❑ Open Bottom © Manteca Dia. of Well Excavation Dia. of WeII Casing I <br /> Steel Specifications <br /> U Domestic/Private XX Gravel Peck n Tracy Type of-Casing— <br /> C] Public I'1 Other © Della Depth of Grout Seal 50` Type a} Grout�ar'Col1ductoY' <br /> (trrit}ation ^Approx. Depth 0 Eastern Surface Seal Installed by- drl 1 ler Cemented In <br /> Repair Wo'rk Done L] 'Type of Pump H.P. State Work Done _ <br /> Well Destruction O Well Diameter Sealing Material i Depth �- <br /> Filler Material i Depth �4kloi <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 0 REPAIRIADOITION CI DESTRUCTION G iNo septic system permitted if.ptiblic iewer'is' <br /> I available within 200 feet.) e <br /> Installation will serve: ;Residence— Commercial__..._ Other" r ""' <br /> I{ -TNumber of living units: Number of bedrooms ' <br /> f -' Water table depth ' i <br /> Character of soil toYa'depth of 3 feet: __... .. - <br /> E SEPTIC TANK. ❑ Type/Mfg, Capacity No. Compartments <br />` PKG. TREATMENT PLT. C) Method of Disposal- <br /> Distance to nearest: Well Foundation Property Line <br /> LEACHING LINE 0 No. 8 Length of lines Total length/size <br /> ." FILTER BED n Distance to nearest: Welt Foundation Property Line " <br /> I . SEEPAGE PITS 11 Depth Size Number 5'1 c 0f7(jU�^' Cr <br /> SUMPS Ll Distance to nearest: Well Foundation____. _Propsrty;Line ' _Irtc?€I'!.ed i r, <br /> I hereby certify that I have prepared th;s application and that the work will be done in accordance with San Joaquin county ordinances, state taws, and <br /> rules and regulations of the San Joaquin County <br /> Home owner or Eicenaed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, t shall not <br /> arriploy any person in ouch manner as tp become subject to workmen's Compensation laws of California." Contractor's hiring or subcontracting signature <br />!. eertiNes the[ollowing: "I certify that in the performance of the work far which this permit is;squad. I shall employ parsons subject to workman's compensa- <br /> tion laws of California." <br /> The applicant must call for all required inspections. Complete drawing o e rse s;d _ <br /> Signed X Title: Date: <br /> Hennings Bros. By 3-'6 <br /> DEP NT USE ONLY <br /> Application Accepted by' Date Area d` G - y <br /> Pit or Grout Inspection by Date Final Inspection by-1-14, <br /> y Dots <br /> �6 V/ -=�G/ <br /> Additional Comments: <br /> Applioant ^ Return all copies to: SAN JOAQUIN C TY ` IC EAL SFR CE f_ Gtr 2 <br /> ENVIRONMENTAL HEALTH DIVISION PERMIT/SERVICES� _ _ - `- 445 N SAN JOAQUIN, P O BOX 2009, STOCKTON, CA 95201 7' <br /> INFO AMOUNT DUE AMOUNT REMITTED H RECEIVED 9Y DATE /PERMIT"N0. <br /> . EK 13-24 IREV.0 51 <br /> ` S EH A-20 <br />