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`�- APPLICATION SANOAQUIN COUNTY PUBLIC HEAL ENVIRONMENTAL HEALTH DIV S 445 N SAN JOAQUIN, PHONE (202p P 0 BOX 2009, STOCKTON, C Abif PERM TEBP RES 1 YE FROM DA (Complete in Triplicat ) q Application Is hereby made to San Joaquin County for a permit to construct end rI e application Is made in compliance with Ban Joaquin County Ordinance No. 549 an and the Aulee and Regulations of SanThis Joaquin County Public Health Services. Job Address 6106 E. FRENCH CAMP ROAD Ciry MANTECA Lot Size/Acreage 66 AC. owner's Name NATNE C . CASTLE Address 6106 E. FENCH CAMP ROAD Phone 982-1641 HONG ENGINEERS, INC. 4578 FEATHER RIVER #A R.C.E. Contractor C . CHANCE HONG Address STOCKTON, 95219 License No. 14269 Phone 476-0011 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well L7 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO. PROP. LINE _ PAAZT1 FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Opsn Bottom ❑ Manteca Die. of Well Excavation Dia. of Well Casing f7 Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing- Specifications Il Public 1-1 Other fl Delta Depth of Grout Seal Type of Grout 1 I Inigalion _Approx. Depth I I Eastern Surface Seal Installed by \ Repair Work Done ❑ Type of Pump H.P. __ State Work Done _ d Well Destruction ❑ Well Diameter Sealing Material L Depth Depth Filler Material 16 TYPE Of SEPTIC WORK: NEW INSTALLATION I REPAIR/ADDITION I I DES G +al,I.Qeplie system permitted it public sewer is 11,� 1• lois within 200 feat.) Installation will serve: Residence _ Commercial_ Other APR 2 7 1994 Number of living units: _ Number of bedrooms Character of soil to a depth o/3 feet: SAN JOA(_ � COUNTY able depth j SEPTIC TANK ❑ Type/Mfg EN LTH QW.1 1 impartments PKG. TREATMENT PLT. ❑ Method of Disposal ^ Distance to Foundation Property Line \ ' LEACHING LINE ❑ No. b Le i,%ktJL1 I Total length/size FILTER BED ❑ Distance to n asst: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ Jy, 1 hereby cenify 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 t 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, 1 shall not employ any person in such manner as to become subject to workmen's compensation laws of California." Contractor's hiring or sub-contracting signature cenifies the following: "1 cenify 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." PERCOLATION TEST The applicant r II required '� ci s. Complete drawing on reverse side. MS-93-113 Signed Title: PRErS • Date: 4-27-94 �l FOR DEPARTMENT USE ONLY Application Accepted by `. Date Ars �_ f n Pit or Grout Inspection by Data Final Inspection by Det Additional Comments: Applicant - Return all copies to: Ban 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 RECEIVED BY DATE PERM17'NO. II INFO ' �