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APPLICATION SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION t` 445 N SAN JOAQUIN, PHONE (209)468-3420 � .: P O BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete, i.n plicate) 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 8 1J Fisk Rd City City {Manteca Lot Size/Acreage 10 acres __ Owner's Name Senn L BOvd Address Phone 836-0039 Contractor Hennings Bros. Address 3525 Pelandale Mod. License No. 290813 Ptione 545-1185 TYPE OF WELL/PUMP: NEW WELL XX WELL REPLACEMENT Cl - DESTRUCTION ❑ out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well [3 DISTANCE TO NEAREST: SEPTIC TANK 1401 SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS —165 1 INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 19 pia. of Well Casing u C7 Industrial ❑ Open Bottom Manteca Dia. of Well Excavation _ g XIXDomestic I Private. `Q(Gravel Pack ❑ Tracy "Type of Casing_ PVC _ Specifications 0 It I'l Public /la Other n Delta Depth of Grout Seal 1001 Type of Grout I i Irrigation 1Approx. Depth I I Eastern Surface Seal Installed by drl l ler Repair Work Done U Type of Pump H.P. IState Work Done_ f4 Well Destruction ❑ Well Diameter Sealing Material Depth Depth Filler Material & Depth TYPE OF SEPTIC WORK, NEW INSTALLATION I 1 REPAIRIADDITION i I DESTRUCTION l I (No septic system permitted if public sewer is available within 200 feet.l installation will server" Residence_..._ Commercial— Other I Number of living units: Number of bedrooms Character of coil to a"depth of 3 feet: Water table depth SEPTIC TANK. D TypelMfg, Capacity No. Compartments PKG. TREATMENT PLT ❑ p$ t# µre ;, Method of Disposal (� ;t s .,` 'F' GJi - .f' �f•SA-a - _ V ' Drstance to neare§t. _ " Well Foundation Property Line LEACHING LINE ❑ No. & Length of.lines Total length/size FILTER BED L-1 Distance to nearesty Well Foundation Property Line �r rn nn SEEPAGE PITS I I Depth Size Number `''" ";t' "•" SUMPS Ll Distance to nearest: Well Foundation Property Line a DISPOSAL PONDS ❑ t 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, and 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 required inspections. Complete drawing on reverse sidtf Signed x Title: Date: 9-14-92 FOR DEPAAMENT USE ONLY 46 Application Accepted by. Date + 1 a L Pit or Grout Inspection by DateaI Inspection by i Additional Comments: Applicant - Retu' all copies to: San Joaquin County Public Health Services Environmental'Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 {� FEE AMOUNT DUE £ AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. f INFO ]7'],[ Sr . EH 13.24 JAEV,r i n 5t ,c t� ✓�Y r✓ �� EH t{4e '© _