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' APPLICATION FOR PERU �p 1IN SAN JOAQUIN COUNTY PUBLIC HEALTH QQ3'&��lt�{{ ^" ' 445 NNSANR JJOAQ IN, PHONETAL DI IV (20995A?PAnQ �C P O BOX 2009, STOCKTON, CAI �^ PERMIT FIRES 1 YEAR FROM DASH tn�v f1�f►BD �e ' (Complete in Triplicate) Application is hereby mtade,te San Joaquin County for a permit to construct and/or install the vork herein described_ Thle ' appliratim to made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Reiulatlons of San Joaquin County Public Health Services. Job Address 313 KRELL RD. city FRENCH CAMP Lot Site/Acrerge ' Owner's Name FELIPE HERRERA Address 313 KRELL RD . FRENCH CAMP Phone 982-4793 Contractor HENNINGS BRAS. DRILLING Address 3525 PELANDALE AVE . License No. 290813 Phone 54 5 118 5 — ' TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT n DESTRLICTIONKXDut of Service Well 0 PUMP INSTALLATION D SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well C7 DISTANCE TO NEAREST: SEPTIC TANK _ SEWER LINES DISPOSAL FLO. PROP. LINE — U ' FOUNDATION _ AGRICULTURE WELL OTHER WELL PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS !V•' ❑ Industrial D Open Bottom ❑ Manteca Dim. of Well Excavation_ Dia. of Well Coming ' Cl Domestic/Private ❑ Gravel Pack ❑ Tracy Type of Casing______. Specifications I"I Public 11 Other n Dona Depth of Grout Seal Type of Grout I I litigation _Approx. Depth I I Eastern Surface Saul Instedad by Rapsir Work Oona ❑ Type of Pump H.P. State Work Done ' fi " Seing Material i Deth N T n N T TFfr o sv koWait Destruction idX Wed Diameter Depth Filler Material a Depth Lt $. TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo seplic system permitted it public sower M 7\ ' available within 200 feet.) Installation will serve: Residence_ Commercial_ Other Number of living units. _ Number of bedrooms Charactn of sole to■depth of 3 fool: Water table depth r SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. D Method of Disposal Distance to nearest: Well_ Foundation — Property Line ' LEACHING LINE Ll No. A Length of lines _ Total length/site FILTER BED ❑ Distance to nearest: Wall Foundation _ Propmny Line ' SEEPAGE PITS 11 Depth _Sire Number_ SUMPS LI Distance to marmot: Well Foundation Property Line DISPOSAL PONDS ❑ 1 hereby certify that 1 he" prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state Owe, and rules and regulations of the Sen Joaquin County Home owner or licensed agent's signature conifies the following: "I certify that In the performance of the work for which this permit is issued, I Mall 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 ceniies 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 compenam- ' tion laws of California." The applicant must call for aE required inspections. Com (•ate draw" on reverse side. Signed x)� Tiele: oats: —1 — 10-94 ' FOR EPAR ME USE ONLY Application Accepted by —� • Date Arms ' Ph M Grout Inspection by Date Fins)Inspection by L-✓ C -- Data f1 Additional Comments: C✓114Z/.5se/ /e" er'Cr5'ruCfZ� Applicant - Return all copies to: San Joaquin County Public Health Services °tA�`- 445EnvironmentalN Health Perml 12009, c 08 Blatt. ��-�V��R�� 495 N Sao Joaquin, P O Boa 7009, Stkn, CA 95 1 1+361 IFEE NFO AMOUNT DUE AMOUNT REMITTED k H RECEIVED by DATE PER �N 11th ISEV..'Mel 1�. j w t..a y