Laserfiche WebLink
k V d SAN J0AQUIN%-5LOCAL; HEALTH DISTRICT <br /> k -FOR OFFICE USE: 1601 L. Hazelton, Ave- Stockton, CA 95205 Permit No. <br /> Telephone 3 (2-09) 4�6-.6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR -PUMP PERMIT <br /> Date Issued <br /> This Permit. Ex .ires l,year-, From Date Issued <br /> Compl ete J I ri Triplicate J <br /> - <br /> Application is hereby made to the San Joaqu;in,Local Health. Di.s.tri.ct _,for .a. perm_lt-to=construct . <br /> and/ae,,install 'the.'work -hehei:n destriUed ..This:app1icatTan ,is _made '.in ;comp1-i.a,nce with, San ' ._` <br /> ` Joaquin, Co'un•ty Ordinance No.- 18.62 and the ,Rules,,and_RegulatTonsrod, the :San., Joaqui n Local Health <br /> District. W:., r.) <br /> 3 <br /> EXACT STREET`RDpRESS, I ©D 0A/'' / 1�1 <br /> Owner's Name— � t�}/I1Ll�_.,. . ..... .._...... ---... P'6ne <br /> Address:.. <br /> Contractor' s Name -6 AGC,/"t License# Phone 7 _7 "7, <br /> TS CERTIFICATE--OF-14ORf:t -­—YES, <br /> TYPE-OF—WORK (.Che,cQ .NE.W-WELLM -DEEPEN -RECONDITION DE'ST'RUCTIN.M `-_-�-_ - - -- - <br /> WELL CHLORINATION Q WELL ABANDONMTIS OTHER 0 <br /> PUMP INSTALLATION 0 PUMP REPAIR LD PUMP REPLACEMENT L <br /> DISTANCE TO NEAREST: SEPTIC TANKSEWER LINES <br /> _ JF6rJ'PIT PRIVY .� <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER ---� <br /> PROPERTY LINE PRIVATE DOMESTIC WELL P-UBLIC DOMESTIC WELD O <br /> INTENDED.USE TYPE OF WELL CONSTRUCTION{SPECIFICATIONS <br /> IndustrialCable Tool Dia. of Well Excavation <br /> Domestic/privates Drilled Dia. of Well Casing <br /> Domestic/public Driven Gauge of Casing <br /> j Irrigation , '` Gravel Pack Depth of Grout Seal - <br /> Cathodic Protec; <br />