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' APPLICATION FOR PERMIT �37Lt SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ' ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468 0 P O BOX 2009, STOCKTON, CA' 912031t►4� J PERMIT- EXPIRES 1 YEAR FROM D (Complete in Triplicate) Application is hereby ,rade to Ban Joaquin County for a permit to construct and/or install the deacr Thi ' application is sate in cowliance with San Joaquin County Ordinance No. 549 and 1862 and the Au1Es time o Joaquin County Public Naalth Services. Job Address 313 Krel l Rd. City French Camp Lot Size/Acreage ' Owner's Name Philip Herrera Address 313 Krell Rd., French Camp Phone 982-4793 Contractor Henn incfs Bros_____Address 3525 Pelandale, Mad. License No.Z.Q813 Phone545-1185 ' TYPE OF WELL/PUMP. NEW WELL ❑ WELL REPLACEMENT XX DESTRUC'TION)jX Out of Service Well D PUMP INSTALLATION D SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well n OIS'ANCE TO NEAREST: SEPTIC TANK _ 60 ' SEWER LINES DISPOSAL FL.D.6Q'}_ PROP. LINE , ' FOUNDATION ____. AGRICULTURE WELL OTHER WELL 161— PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS D Industrial C Opan Botta. Q Mameca Die. of Well Excavation1 — Dia. of Well Casing fX Domenic/Private IRI G,aysf Pack ❑ Tracy Type of Casing_., PVC Speciflcehort I Fm 1"I Public Cl Other fl Delta Depth of Grout Seal 100, Type of Gm t-fiP„nton7 tP I I brigation __Approa. Depth I I Eastern Surface Seal Inslaliad by dri)ler Repair Work Dau 0 Type 01 Pump H.P. Slate Work Dons_ Wall Destruction C% WON Diameter 6° Sealing Material i Depth HnIp. p1tjp/hFintr)nft.P Depth Filler Material i Depth Hole Rluo/bentonite TYPE OF SEPTIC WORK: NEW INSTALLATION 1 I REPA(R/ADDITION I I DESTRUCTION I I INo septic system parmilted it public sewer m ' available within 200 fast.) Installation will serve: Residents_ Commercial _ Other Number of living unity: _ Number of t»droonn Chitectet of me to a depth of 3 fact: Water table depth ' SEPTIC TANK O Type/Mfg CapacityNo. Compartments PKG, TREA•MENT PLT.D Method of Disposal Distance to merest: Well- Foundation ___ Property Lin ,. LLACHING LINE ❑ No. 8 Length of line Total length/size FILTER $ED D Distance to nearest: Wee Foundation _ Property Lin SEEPAGE PITS I I Depth _Site Number_ SUMPS LI Mamma to marrrar. Wall Foundation Propaarty, Lina DISPOSAL PONOS O c, 1 MfNry Certify that I hew prepared this application and that the work will be done in accordance with San.Joaquin county ordinances, state laws, and rules end r"04horu of to San Joaquin County Horn owner or licensed agent's slgntura certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 ahou not employ any person in such manner at to DetorrM subject to workman's compeneatior,laws of Lalilornia."Contractor*%hirin or sutrconrracting signtute Certifies the following: "I certify the,,in the performance o1 the work for which this permit is issued, 1 shall s 11W C ' tion )ewe of California," no o! L) The applicant must call for an required inspections. Complete drawing reverse stale. L signor x Hennings Bros. BY title. C - pets: 7=12a_ 4zkn:Q_ FOR DEPA MENT USE ONLY3.lKJy`� Id-�r —�Applionion AccaptvJDau AnaPit or Grout Inspection by iw�9i0:�_ Date—l}_ Final Inspection by ,p Data Addhionel Cimments: �� -n-a; ,. : _ r!=..ic.-Cf At /'+-c CG� 17447 Ih A'ar i/ rvG.� ✓ 5<'� Applicant - III all coplea to: Ban Joaquin County Public Health Services 1 Environmental Nealtb Permit/Services -/w0 O/� ✓ � a.L�`r'�`� f ` 445 N San Joaquin, P O Box 2009, Bike, CA 05201 r / „fin„ *,A- io, J'oiiVA G7 Y J40FEE NFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVEO BY DATE PERMITNO. Gx �lrxutv.,,.s, Z- 0C ,use � seg