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-x r' <br /> - <br /> 7 <br /> r <br /> APPLICATION FOR pERMIT <br /> s <br /> s' SAN JOAQUIN LOCAL HEALTH DISTRICT Y° s " <br /> I 1501 E. HAMPTON AVE„ STOCKTON, CA <br /> ' Telephol (209)456.6781 <br /> 4 y PERMIT EXPIRES i YEAR FROM DATE ISSLIED <br /> (COmPlete in TripfiCatel <br /> fi, 1 Application fs hereby nada to the San Joeoun Local Health Dherkt for a <br /> Ill in tom <br /> e+Eaneo with San Joaquin County Ordinance No.549 for few parrrlit to cons <br /> Local andla instal tfN work MraMt,I <br /> zs , Local Health bisrirc(,• age a No.1%2 lar well rlb+d:;Thla'` <br /> Joh Address ! P alld the RWas Mtd PeptlaHorN Of tiu San JaprtUt a <br /> Owner's.Varve , IO1 rS PM <br /> Y."' + Address r� L .c i -t r4 <br /> Contract .4, `+ PitOrte <br /> Address <br /> r TYPE OF WELLlPUMP:. <br /> NEIN.WELL © License Ill . <br /> WELL REPLACEMENT ❑ i°t101y N <br /> 1 I v PUMP INSTALLATION ❑` DF.STRUCTtON <br /> a DISTANCE.TO NEARESTa SEPTIC TANK SYSTEM REPAIR r <br /> — SEWER LINES <br /> r FOUNDATION DISPOSAL FI.D. <br /> r AGRICULTURE WELL <br /> --��PRO UN <br /> INTENDED USE �—� OTriER WELL PITS,'5UMP5" 5� <br /> { '* Q Indttatrh C]TMO PES OF WELL PR04LFi4R`pRE4 CONSTRUCTION SPECIFICATIONS ; <br /> Aen 8ortom Ci Manteca <br /> ?1 esp rti ` s ' v CI DtNttestrelPrivah is Gravel Pack Dia.Of Well Exeavatiortr <br /> 11 PtaWic !1 Other O Tracy' Type of•^asi '—�� `Dia of Wirt <br /> kriwtion r1 Deha Depth of Grout Seal <br /> ^—APWO%-Depth i 1 Eastern <br /> n „Repai►Work Dory _'q Surface Saal Installed by �of�+t <br /> Type of Pump.. k.P. A- ax�C <br /> Well Deatn►ction �'O -Wall Diameter •• ^ <br /> a. .Seat Sate Work Done <br /> Depth ,- ng Material(top 50'1 <br /> TYPE OF SEPTIC WORK: ,NEW INSTAL Filter Material feelow 50'1 " " <br /> y r lAT(ON )Di <br /> TION 11 DESTRUCTION I i.fMo septic ayatarn Ya ,, 1 <br /> i eltayNon VVM Sall R I <br /> Pfetnrtrad N <br /> eyidenoe� Gomrttereiar� a avarTabre wrcprin� PuhEc soarer to . <br /> Numh:r m Irving <br /> Other feet-1 <br /> [+nits: Number of ooms <br /> r' Characbr Of sol to a depth of 3 feet. <br /> SEPTic-iANK 1 t l <br /> YPa 9 tWater tftk depth .. <br /> PKG TREAT(NEN7 PLT.❑ capacity � No <br /> y r COmp!�Lrrynta = 'raft <br /> 1 Method I*.D �:' : <br /> Dista�rce <br /> to nOarest Weii ,�j Y-�3EZ, _ <br /> _SAL.Foundation_ Sit 1 PropanY.l iry ` + <br /> LEACHING LINE <br /> " �L ✓.; No.A Length of linea <br /> r , >FILTER RED <br /> !] Dhtaoce to nearest:' WA notal length <br /> —�— r FoundationP ° <br /> SEEPAGE'PITS �r Prop4rly L'kw k�� <br /> Depth - - <br /> SUMPS Site 1. <br /> Ll Diatanea to nearest: Wali rNumbe1 <br /> DISPOSAL PONDS Q -�' .,Foundation <br /> --'ProPerrlr Lina <br /> I Lasa n artily that I f t Prepared this application and that the we <br /> wit <br /> ,- and"aOul+tiOry o!the San Joaquin Local Health Dt3trict. 11e dO^e in aeeordanre wink Sam joaql jot"" <br /> dl Harry ownw Or lcensed agent's <br /> Corwin the(panel in such rtynner as OKI <br /> bellwhich <br /> e conau f � r earl owl In the peritxmanp of � rl�wl Mme'+uM. <br /> Olowfng:'9 bject to wO,krryn•s cawork <br /> .;�in"of sadly that in The Periamanca of the WOrk fa whichnh thl is of Califon C h a hiring P@lmit iq j j. <br /> California. <br /> The <br /> ant t calf fa hep in <br /> permit h haued i all <br /> Signed ' spections.Compete drawirp pr reverse f �M�OY Peraay�atlto warkRytt tMya t <br /> T Tito: t .: <br /> FOR DEPARTMENT USE ONLY <br /> A1130kation Accepted by <br /> x �k or Grout Inspection Date + <br /> - mal Inspection " <br /> /S6-e7At. QDalai <br /> ' Appic"•Roll al IOp 34�3s21 d Manttrctr W3.710e w t ,. <br /> t Opise E!wkOnrrAMal Hal Perm( ❑Tracy B 8386 e <br /> . t/Services 16p}E.Harehon Ave. P 0 Box mpg Stks T • a:n t4 <br /> CA (11 xt a" r <br /> INFO - AMOl1NT OItE <br /> AMOUNT REMrTTEp <br /> - _ CASH RfC'EryED dY - DATI.y.EH rEl1A�7' s* <br /> u EH td n tally,r,.s� k ' <br /> P <br /> l <br />