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is i ' /S' - i3<'tul[ Sit..,/ APPLICATION �- ':�t-3 -7 7S`- it1 - C'(t- SAN JOAQUIN COUNTY PUBLIC HEAL ffixg ENVIRONMENTAL HEALTH DIVfTf �} 445 N SAN JOAQUIN, PHONE (20 -� P O BOX 2009, STOCKTON, C �Lp PERMIT E%PIRES 1 YEAR FROM DUED a.a fc i (Complete in Triplic N (� C�6o3 Application is hereby made,to San Joaquin County for a permit to construct and/or install the wor �bed,�Th1/ application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulat on i Joaquin County Public Health Services. Job Address 5336 S. Henry Rd. C,ty FarmingtonLot Size/Acreage 40 acres owns(** Name Kevin Turner Address 1321 San Joaquin, Escalon Phone 838-1565 Contractor Hennings Bros. Address 3525 Pelandale, Mod. License No. 290813 Phone 545-1185 TYPE OF WELL/PUMP: NEW WELL M WELL REPLACEMENT n DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C7 DISTANCE TO NEAREST: SEPTIC TANK 100' SEWER LINES DISPOSAL FLD. 100' PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS 1ZfJ r INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Ci Industrial ❑ Open Bottom ❑ Manteca Die. of Well Excavation Dia. of Well Casing u C Domestic/Private It Gravel Pacl:7 ❑ Tracy Type of Casing__ PVC Specifications fFn I'i Public Il Other fl beha Depth of Grout Seal 100, Type of Grout BentGn lte I i Irrigation _ Approx. Depth I I Eastern Surface Seal Installed by drl)ler Repair Work Done U Type of Pump H.P. ___ State Work Done _ Well Destruction ❑ Wolf Diameter Sealing Material a Depth `1 Depth Filler Material i Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted if public sewer is available within 200 feet.) Installation will serve: Residence _ Commercial_ Other Number of living units: _ Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE CI No. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 11 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 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 cenify that in the performance of the work for which this permit is issued, 1 shall employ persona subject to workman's compansa. tion laws of California." The applicant must call for all required inspections. Complete drawing o eve se side. signed x Hennnings Bros. By Tide: Date: 9-27-93 / FOR DEPART T USE ONLY Application Accepted by �< Date / /J Area Pit or® Inapeclion by Date Final Inspection by Date l�-i Additional Comments: O ' fio Applicant - Retan all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, P O Box 2009, Stkn, CA 95201 w' NEE AMOUNTTyDUE AMOUNT R/E{M�I7TED CASH RECEIVED BY DATE PERMIT N/0j�/J- . EN;324[REV.irxsl [d �lYv �✓t/(/��1 EN,4]0