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APPLICATION <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SESVOTTES 4> <br /> ENVIRONMENTAL HEALTH DI V I S I <br /> 445 N SAN JOAQUIN. PHONE (2 9)4 l�*It94tl <br /> P O BOX 2009, STOCXTON, CA 9 1TAC <br /> PERMIT.EXPIRES 1 YEAR PROM nATEIISSUED <br /> (Complr.te In Trip!ic:ate) I <br /> Application is hereby aide w Sao JoeVuir. County for perm.[ to cenetrunct end/or install the vo.k herein leetoed. This <br /> application Ss asst, In cram llance vlth San Joaquin County Ord:nerce No. 5L9 and 18,1 and the Rules and Regulations of San <br /> JoaeUio County Public Health Service.. FRENCH <br /> 1099• S. SARLAN ROAD <br /> Joe Address . - 46?t-$EAPO .r".r 3Le.Tf.- jl(, <br /> STEVE IENETO, JR. Ald,lt S.ACRAMENrO 95491- PPune _(9141371 0 <br /> Ownei a Name c. <br /> HONG ENGINEERS, INC. 4378 FEATH_.tt RIVER A R.C.E. <br /> Connanor C._CAJ CE 1f�NC!_._Aoalra_STT--QC1;TQN_f... CA 9Rf'�9.,.rt ens,No Phone-4-7 01. <br /> TYPE Of WELL/PUMP. NEW WELL -I WELL PEVLALF MEN] Fi DESTRUCTION Ll Out of Sarvlce Wall ❑ <br /> PUMP IIISTALI.ATION C SYSTFM REPAIR L. OTHER ❑ Mont torlrlg Well ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _ _ DISPOSAL FLD— PROP, LINE <br /> FOUNDATION AGRICULTURE WELL _— OTHER WELL PITS/_SUMP'. <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> 1 ❑Industnal ❑Own Bosom C] Manteca Dra of Well Excavation DM at 1.11 Casirp <br /> Public <br /> atavel Swabeatrom <br /> (I Puc/prive ❑GrPeck Ll LType of Cas,-g---- <br /> ------ <br /> 1'I PuWk Il Other 1�Oeba DeDIn of Grom Seal _ _ Tye.of Gnaw <br /> I I Irrrpatian —Apnex. Deplh I Eastern Sudan Seal Instilled by <br /> Rawir Work Done U Type of Pump H P. hate Wnrk Done_ <br /> Well Def[ructgn ❑ Well Diameter <br /> Scaling Material ADepth <br /> . <br /> Depth Filler Material A Depth <br /> TYPE Of SEPTIC WORK: ;EW INSTALLATION f IIEPAIR IADUITION I I DESTRUCTION I I IN.dplel w Ifnn 7g11ai111�Il P,•N,c wwar n <br /> Inslallaian wMl NNf: Relidenn CWnhNrcral._ Ullmr <br /> Number of xwnp units;_ Numeef of Dadroo it �ii <br /> Character of sox u.depth of 3 NNI: .V VEOTra dep1n. <br /> f SEPTIC TANK O Type/Mig Capacity-- R-T-,yt "mor's <br /> PKG.TREATMENT PLT.❑ 'Mee�I l 9 Orson" <br /> Distance a eveft. Well Foundation Atl�`perly¢ <br /> N�iY,,�,�,� <br /> IS�L�" Ati $ERV{ <br /> LEACHING LINE CI No.A Length of;,no. a$"DppITM <br /> � FILTER RED C.1Disunw u <br /> Io nsaat: Wall . Foumwau _V6on— Y hik' <br /> t1EEPAGE PITS I Dapin Sue ._ Numer <br /> SUMPS LI Diat.nce to nteresl'. Well Foundation ProwrW Line <br /> DISPOSAL P01.05 ❑ <br /> 1 hereby canilY IMI I neve peered IMf appiKatipn and that the work will be done in accordance with San Joaquin county ortlmmws. Nu leaf,end <br /> r rules Wit rpulelrom of m.San Joaquin County <br /> Home pwmr or licensed agen'�f signature wrVlNf IDs following <br /> '•I certify that m IM wTfarminta OI lb work to,MIKn this wrml u ruuad.I shaltrql <br /> employ W,bison in such mana.10 become Wbp ,to workmen s comwnY4on 4MN of C.IAarm.*'Contractor',hiring w fuDConwaltmil signature <br /> cWI1N.tM IoNo,,u is-,[Wily IMI ip the performance of Inc work fpr which in..want Is Issued.11m11 empbY wrtlnf WDNc11.workman.compenw <br /> tion law.of C.lhornio." PERCOLATION TEST SA-94-31 <br /> Tfs apYlKanl at call fp 0'fact uad nspovi.n1s. Compete arowmg W revvss side <br /> Spared . .1 ' <br /> F IA�CVi. Title. CIVIL ENGINEER Date. 6 e. <br /> y�— <br /> 60 <br /> O FOR 7EPARTMENT USE ONLYpr <br /> Do.. Arai Z I/1 <br /> e Application Accepted by ---- <br /> pit Of Grput Inspection by - Dale Final Inspection by _ Dau r�4� <br /> Atld'n;mat Comr+nu: <br /> Applicant - <br /> Return vll e11t"9 lo: San .tesVN In Cnunrg PUc1Ii Nealtn S..rvlcrx �.6G' <br /> govt ronaen t al -.in. P Pa ratt 001.[liar CA 95001 <br /> nes N San .1wV•.1 n. P O Rai 2]Ux, Ytkn, <br /> FEE AMOUNT DUE AMOUNT RFMITIFD C K N REC[IYkD DY y) oDATE fT�Ron,HO <br /> r �ZZZ.. INfO <br /> .H.a>a.req Tr 'l R _x.73 u� <br /> Lx r.a / �r <br />