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�r <br /> aS <br /> .-APPLICATION FOR PERMIT <br /> AtiUiN LOCAL HEAi.TH;DlSTRICT <br /> SAN JO <br /> -r, .7A r�' t HAZE�TDN P►VE. 'fO KTDN. GA <br /> ���" <br /> ,. M s� EQ u <br /> scnbed 114:013011-000f <br /> yvOrA herbin dasin <br /> Rulbd A of the SenJoaq <br /> r <br /> a � <br /> 1 <br /> arc :v s DESTifUCTION <br /> v r E WELL ❑ ywP �.� s � OTHER ra <br /> PE, <br /> pFIVELI.IPUMP SYST PAl�t <br /> SYAtLATION la p1SPOSAt FLD____.—PROP. LINE, <br /> SEWER LINES 4 <br /> er. <br /> r ]iSUNGS"Tf31 E,4FlIr5T:"SEpTIC#ANCC --- �THER.WELL_�--- P4TSISt3MP5` <br /> AGRICULTURE WELL. --� �s <br /> € ;FOUNDATION --- , <br /> ONSIRUC'1iONSPECIFICATI4NS <br /> v , 1NYfND�D5£ A TYPE OF WELL PROBL�EMS `` _� p� of Weil Casing Y <br /> D18of Well fxcairatl'A arts t <br /> ❑ Industrial 0 Open Bottom © Manteca' r •Typerof <br /> ` `D Gravel Pack ❑ Tracy k " G€rtlirt Y r c <br /> fO DontesuclPrwats � <br /> n other ,�, n <br /> Delta <br /> OepthOfaCl „ k "1r " + x •," •rF? <br /> .. .v ,:.F. <br /> ox th)' I l Etastern a <br /> surface Seai Installed by y <br /> v"« �APPr Oep - Do <br /> I Llrfigat+on H P State Work.. A <br /> Repair Work Gone [] Type of Pump- —�-�-- - <br /> sealing +latedal ttpP '1 <br /> Welt Diameter �. fi0 �' '" i4 }"w ` L, r <br /> w `d Wsll DWfuctiort e ❑ ; <br /> s ? <br /> Dept . Filter Mgte!. IBe , <br /> rmttted If public sewer <br /> No septic system pp�� <br /> avaitabie within 20E3eet 1 , <br /> TYPE OF SEPTIC,WORK_,NEW4NSTALiATi N'1.1 fiEPAIR/AD ,tITION f 1 Df Tgl1CTi0� �r* <br /> r " Commercial Other`""" , <br /> 'Installation will Sartre: Residence's + °� � <br /> rtts_ '8 f ` <br /> Number of I'niing units: Number of Adroo �� �'�� � ``� Watsr teW6 depth .- <br /> r Character of sail to a depth of 3 feet _ �` CaPacltY Na: Compartments <br /> ,��;,....__,,p --TypelMig <br /> -SEPTIC'TANK +. _ Method of Disposal <br /> PKG. TREATMENT <br /> PLT. Y 'w, <br /> a rest. Well Foundaaon_. Property Line�"..s"" mt <br /> h Drstanoa to rtes3 rr <br /> len <br /> gth1 <br /> LEACHJNG LINE: "Ci . No.;&length of linea: }, Property Line ---- <br /> ' Foundation <br /> FILTER,BED b Distance to nearest: Well �— <br /> Number <br /> SEEPAGE PITS f l I#Depth Sire Foundation — Property Line <br /> SUMPS Ll Distance to nearest: ; Well ry '* <br /> DISPOSAL PONDS ❑ <br /> 1 hereby certify that 1 have prepared this application and that,the work will be done in.aocordsnce with Son Joaquin county.ordinances,state laws, and <br /> rules and regulations of the San Joaquin Local Health Dli trict. I cerefy that perfonrian�of the work Jar which this permit is issued, I shall not <br /> ure <br /> Home owner or licensed agent's signature cartifies the following: •• <br /> employ any person in such manner as to become eubiect to workman's compensation taws of Catif0rnW"Contractors hiring,a► workman'sgcompetnss- <br /> certifies the following:_;'!certify that in the performance of the worst far which this permit kiatuad !shall employ Person.` l <br /> % tion laws of Cairk <br /> lifornia." <br /> liked i ions. Complete drawing on re ►ase sides < <br /> The applican[ call for an.required in } 6"' <br /> 11 <br /> nfo <br /> rlbdF t o i '• frtrt �_ <br /> ;0 y f r <br /> � <br /> 1 � �•� y+ t o 'T, <br /> i- �. i Ta� 7�� a ,. r u•�3', a'�i�d��3 � � '� a ,� s �.a yw'�.,� <br /> PI <br /> Oruro ul� hspactbn <br /> Additlonal Cory►rnents tie" <br /> entana TrMcy <br /> V� � � � }Sr�' A6�-078I s���:r Lad1"�3f�-3B21` �"Hea "`.Ply �'1®61 �Hasa �0 $ ��9�Stic.r�+P►'�101 a" �s�'�" ' <br /> �►pplictgtt•Returtl e�stopise.�o _ ;,. �-`' ' <br /> MTF.NWTj <br /> g. <br /> EMOliN1 DUE § CiW f llfblf h + ; <br />