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��������K�� FORPERMIT' <br /> - � <br /> ' ,. .~ ' . T_ <br /> SAN JOAQUUN LOCAL HEALTH DISTRICT ' <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> � ---'_- -_- 466_ 681 <br /> PERMIT EXPIRES liYEAR FROM DATE ISSUED, <br /> (Complete in <br /> Application is hereby made to the San Joaquin Local Health District for a-permit to construct and/or install the work herein describid. This application is <br /> 'nFs of the San Joaquin <br /> made..compliance.~..~.Joaquin County~....~~.,..~.~ ~..,°. .~ ...^for well/pump~~ .~Rules�and Reg,~~~ <br /> Local Health-District. <br /> Job Address 900 -F'4, Cit� L;t'Size PM <br /> ~-^^ ~ '~~'~ Address <br /> License e <br /> � -~.tractor~ <br /> , rrps OF Wsu/pump: NEW WELL u| - ` WELL REPLACEMENT o <br /> DESTRUCTION O ^ <br /> ` PUMP --T'--AT—' - -Y-T-- R- '-' - ~''-'' >~ W~''' <br /> DISTANCE TO NEAREST: SEPTIC TANK — SEWER LINES DISPOSAL FLD._ PROP. LiNt <br /> 'FOUNDATION — --'AGRICULTURE WELL" WELL PITS/SUMPPS <br /> ! INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFlfcA�bbNS <br /> . _ Industrial - -,-.. Bottom_ - Manteca- ~~ .. Well Excavation. <br /> 1-1 Domestic/Private L-]� <br /> EJ Public 1�10' ther Ll Delta Depth of Gro6t Seal— <br /> .� � Depth 13 . <br /> DVA <br /> Repair Work uvno u /rno on ru . <br /> H.P. State vvnm ovno <br /> Well "e""""°"' El Well Diameter S=wlingwwrerm/ (top vv/ ^ ^ <br /> ' <br /> Depth Filler Material (Below ov/ <br /> TYPE OF SEPTIC WORK:\ EW INSTALLATION LJ REPAIR/ADDITION 171 - -' septicavaila��w���2x0--'-- ' --' --sewe - <br /> Installation will serve: Resi:�Ience— Commercial Other <br /> Number of living units- Number of bedrooms <br /> Character of soil to a deptii of 3 feet: Water table depth <br /> SEPTIC TANK D Type/Mfg Capacity No. Compartments <br /> PKG. TREATMENT PLT. Ll Method of Dispo�al- <br /> : Pistance to nearest: Well Foundation Property Line <br /> LEACHING. .. E `3 Length of lines Total length/size <br /> FILTER --- _ Distance to nearest: Well -_ ....~~.~. Property `"e ; <br /> herebySEEPAGE PITS 0 Pepth Size Number <br /> SUMPS 1 1-1 �; Well Foundation— Property Line <br /> :Distance to nearest: <br /> certify that- I _have prepared_ thi-' application_ _ _- -_ -- .-- 'iII- be don_- -'--__-nce_ with San Joaquin_ county__- , <br /> rules and regulations of the-San Joaquin Local Health District. <br /> Hom <br /> 11 <br /> —e owner- ---ed--=-'-`~---',r---'- -wing-:-,'I 6ekrN-~'- '~ ~~'~^^~~~~ the work for'~^~' ~^~p~^ <br /> it is issued, I shall not <br /> employ any persvinsuch ma�oaxm � ��W� mm �� � �u� �m�m� m� <br /> uv � �o �omno . <br /> "Contractor's hiring or guW�contracting signature <br /> certifiesthe �����m��m��m�w��������m�� |o�������������� <br /> compensa- <br /> tion m�vnrcvmvm� ' ' ' <br /> The applicant tot call for all required inspec ions, Complete drawing on reverse side. <br /> ownxoTitle: Date: 7- <br /> ONLY <br /> ^ °p,~"""' °^^°p�� <br /> byy Date Area <br /> -Pit or Grout Inspec y Date <br /> i ~ <br /> ' Additionaln Date 'Final Inso6ction by <br /> - - ------ <br /> ~~ El am 466-618/ u Lodi 39-362/ u momi�a 823-710* u Tracy miFM <br /> Applicant^ Return all ^"pi a" "^ Environmental Health """""S"""=° '"°' E. Hazelton°"° P.O. Box 2009, Stk. CA 95201 ' <br /> FEE: AMOUNT DUE , AMOUNT REMITTED RECEIVED BY DATE. . PERM'IT'NO. <br /> INFO CASH <br /> + EH 13-24(REV. <br /> -;k— <br /> EH=m <br />