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APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZEL T ON AVE., STOCKTON, CA Telephone (209) 466-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Ii (Complete in Triplicate) } Application is hmeby made to the San Joaquin 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 the Rules and Regulations of the San Joaquin Local Health District.. Job Address 16587 E. Frendkamp Rd. city Ri on Lot Size PM Owner's Name Matt. Frankel=la Address 16655. E. Frenal Cam Rd Ri on Phone _599-2064 ContractorHennings Bros. _Addtess 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 100 SEWER LINES DISPOSAL FLD.100.'_.- PROP. LINE ^ FOUNDATION AGRICULTURE WELL OTHER WELL PITSISUMPS —;, " INTENDED-IJSE-"-i6-�—'TYPE`OF,VVELL� PROBLEM'ARE,"" CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom ❑ Manteca Dia- of Well Excavation 1 211 Dia. of Well Casing 611 n W Domestic/Private R1 Gravel Pack ❑ Tracy Type of Casing PV(' Specifications F1 Public Ll Other Fl Delta Depth of Grout Seal SO t Type of GroutRant011.itP_ j I I Irrigation .T_Approx. Depth I 1 Eastern Surface Seal Installed by dri I I er - Repair Work Done ❑ Type of Pump H.P. State Work Done _ Well Destruction ❑ Well Diameter Sealing Material (top 501 Depth Filler Material (Below 50') TYPE OF SEPTIC WORK: NEW INSTALLATION 1.1 REPAIR/ADDITION i.l DESTRUCTION E I (No septic system permitted if public sewer is t available within 200 feet) Installation will serve; Residence_ Commercial_ Other t Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: =' Water,table depth `\ SEPTIC TANK fl Type/Mfg Capacity No. Compartments° T PKG. TREATMENT.PLT.,❑ i, ?+'I Method'ofi Dispo 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 l I Depth Size Number fvE f?�f V, J SUMPS D Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑; 1 heieby'cerfify ihat'I fia`ve prepared'ihis application and that the work will be done in'accordance W' 4'0San 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: "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." I The applicant must call for all required inspections. Complete drawino rev r side. Signed X 1�enn in s Bros. B Title: Date: 4-5-89 FOR DEP RTMENT USE ONLY Application Accepted by __qDate Area U Pr, Gr Pit or Grout Inspection by ate Final Inspection by Date ' Additional Comments: _ '� an %b r / ❑ Stk 466-6781 ❑ Lodi 369-3621 ❑ Manteca 9 823-7104 ❑ 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 H RECEIVED BY DATE PERM17'NO. INFO ♦.EH13-24(REV.1/H5) < EH 14-28