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Nov — 2 - 90 FR I K - 4 - V I LHtAUG DR I LL IN ..•. -P .`. 0 1 Wr,4lTWU 17 : !5SER 1 A EWV II+OWt`1l=WT�iL ' APPLICATION FOR PERMIT -�rrr``5--31 SAN JOAQUfN LOCAL HEALTH orSTRr . E i V E 0I 1601 E. HAZE.TON AVE., STOCKTON, C i ralepnone czars 466.6781 NOV 2 1990 PERMIT EXPIRES I YEAR FiROM_DATE 1,Sy 1041 �F t.•!_ (Complete NM�NTAL HEALTH ~l N�2~ �: i.... p sty in Triplicate) PERM IT/SERVICES f Applleation is haieby rneae to the San Jott4uln Local Health District for$Permit to Construct and/or install the work heroin d iscrrle matte in Carrlpttanaa with San Joaquin County Oral aea Tn,s eapladon io Local Neolth �l4t+its No. 640 for sewage or No. IW2 for wrtlUpump and the Rules an4 Reptitatron.n+tns San Joaquin f j Job Address0�A / j ` t.l°/t7�0 SZvC Oily ` Lot 8lsf..1 i Owner's Nam a ddross �R�7�11 Gi C fir''_..`. Phone COntratto< dress / License No. 1 TYPE OF WILL/PUMP; NEW WELL 0 POMP INSTALLATION O WELL REPLACEMENT C: DESTRUCTIONPhone r l c f SYgTLM REPAIR O OTHER it Sir+ DISTANCE TO NEAREST; SEPTIC TANK , S<iyyER 1.1fV$S ,r DISPOSAL FLQ. PROP. LINE , FOUNDATION AGRICULTURE WELL OTHSR WGLL�. ,.^ PITS/SUMPS tip INTENDED USE "TYPE OF WI!Lk PROSLEM CONSTRUCTION SPECIFICATIONS r .1 © industrial (5-0—pan aottom ❑ Manteca 'r Dia. of 90 Excavati n Dia. tb1l'nhltBav N �4 Cl Domestic/privara p Gres) PaCk ❑ Tracy Type of CUA9 N Specifications bright n Other ('1 Dolts D th of Grout Seal 17N yO I I frrigafion A 1h ! Type*f f3raxr1�i0,� .� �.,• pprOx. 120pl Eastern Surface Sohl Install%ld by �� r Q Repair Work pons [] Type of Punto _Z6k- H.P. A)114- � � Ststo Wont Done_ " 1300' Won Destruction C Wall Dlamatar Sealing Matarlal Itop SO') c=r! r •.a Depth .1 Filler Matariaf Walow 60'I TYPE F fiEPTit: WQAfC: NEW INSTALLATION1I ANPAIR/ADOITION ! I OBSTRUCTION I I INo septic system pormrtted It pious sower is Inatollation will serve: Residence_ Commercial_ Other availible within 200 feel,I Number of living unite: Number of bedrooms Character of soil to a depth of 3 foot: SEPTIC YANK Water table doom ❑ Type/Mfg Capacity-. No. Comportments ! PKG, Tfif:A7'M>:NT PLT': ❑ -•-. � Method of Ditposal Distance to nearest: Wall _ Foundation . Property Line i LEACHING LILAC C1 No, 6 Length of tinea Total length/stile FILTER OFG 0 Olslw*to nearost: Wall � � Founeatron Propsew Line SEEPAGE PITS i 1 Doplh Sl:eN -.-�,—•.....—_....�..�.,,..� umber SUMPS ::1 Distance to nearest: Well foundation DISPOSAL PONDS [l ---�---- Proaonv Una I hereby Certify the/f nava prvparad thio applksUon and that the work will oe dans in accordance with San Joaquin county orrtinanc,;s state taws, ono rules and reaulauons of tho San Joaquin LOW Maslth Dibiriat. Hama owner or ncansed agent's al¢nature certifies the following: "1 certify that in the patlorrnance of the work for which this perma •s issued,I shalt not employ any parson in such manner as to bocorne subject t0 workman's compensation laws of California."Contractors hiring or sub ContFacting signature CeRiflos tho,foliawiog; 1 sonify that In the porformancr of the work for which this permit is issued, I shall amploy persons subject to worrman's camponsa- tlon law$ of-California." The applicant roust tali fo ailre wired* rions. Complete drawing an reverse tide, Signed X `J Title: QIG e=_ Data: _ -r VO FDR DEPARTMENT USE ONLY Application ACCepted b / Da to Arnk i Pit Or Qrout*nspnctlon by Data ,,, Final InlpemiOR by Date `— Additional Comments: D 5ik 466.8781. G Lodi 369.9821 ❑ Manteca a23.7106 C Tracy 635.8285 f Applicant- Return an coplp;to: Environmen Mass lh Permit/Servicer 1601 6. Hazelton Ave., P,O. Box 200% Stk., CA 9=1 -5� i2s3 IVY— 1117/,Cd saw