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F0� PERMIT � ' Ap��AT�ON pISTRICT 4TH, NEA _..,. .�.. . ,,. `AN JoP►a�'N STOCKTON, CA N J .. - 81 SPA HpxE�r ON _ { 1601 E. hone (209 Te►ep DATE ISSUED Pr �S,�1•Y�Afl FROM .. MST EX l;tate) S a licanon is (Complete in Dnp TH pp it to construct and/or instali the wor aedlR gulations of the San Joaquin e or No. 1862 for well!PunrP and t uiri L�l-K'��Drstrict for a perm ; gan,Joaq fjiriance No.549 or sewag hereby made to the f Or: .. � PM Joaquin Cou N r ; Application is with San } Lot Size in compliance �� ,�`. _ made City . Local Health District. t wk ' Phone ,4� Job Address r ddress �� �' - Phone =- License No I DESTRUCTION ❑ :i�Address � Owner's Name OTHER ❑ �—,—1:ZL ❑ WELL REPLACEMENT ❑ STAWfION ❑ SYSTEM REPAIR ❑ PROP. LINE Contractor NIP: DISPOSAL FLD-� WELLlPU PUMP It � SEWER LINES -� PITSISUMPS TYPE OF OT1iER W��L--r REST: SEPTIC TAN AGRICULTURE WELL DATV CONSTRUCTION SPECIFICATIONS - Dia:of Well-:Casing p15TANCE TO NEA FOUN F 1L PROBLEM pia:of.Well Excavation Specifications TYPE of. ❑ 1Nantec l i ❑ Open sr `: Type of Casing Type of Grout INTENflEp USE ❑Tracy ` Seal � ❑ pelta Depth of Grout T ❑.industrial ❑ Grave surface Seal installed private by , EasterSta ^W Domestic ❑ the _Ron, public publicDepth ❑ H.P. Y 1 Sealing Material (top 50'1 _ *� ❑ Irrigation ❑ TYP%ter ms ermitted if public sewer is t repair Work Done W�� Filler Material 113 `5 'l� I (No septic system p_. REPAIRlADD1TVON ❑ DESTRUCTION avail'able within 200 feet./ Well Destruction D STALLATION ❑ t , a F s SEPTIC WORK' Commercial r Other l 9 TYPE OF w Ce X , Water table depth l ►" ` No. Compartments InstalVation w.11 sere: Number of bedrooms Capacity�� osa i " unitbf 3 feet: Method of Disp i Number of living Type/Mfg r Property Line ' Character of soVl to�TYP i ' Well PKG. TREATMENT � Foundation SEPTIC TANK _: ' T Distance to nearest: Total length/size {16 i Property Line - :' rl .❑ No. & Length of Vines Foundation �t Well ° Distance to nearest: !. 1-EACHVNG LVN,, ❑ Number �t propertyLine .,FILTER BED� Size M w � � — an ❑ s DePh Foundation state laws r Well�� '' in countyOrdrnances, r. ❑ prstahce�to rieare�t: - »,r., --_. , SEEPAGE a ued, I shall q } ... y rch this per is iss Signal _ ' SUMPS. S c - _ -~-�" or subcontracting 1 f oa - lication and that the work !ii be done in aatof the worirantor s hiring; _ rkman's comPe' kDISPOS that I have prepared thaLocai,Healtfi_District Certify that rn the performanceGori erns$ubiect `^1O compensation Laws of Cafify hall erriQVoY,P I heretiyi nature terrifies the following: ' permit is issued,_ _ / ativns of the San Joaquin or licensed agent's sig rulesis r{ormance of the work four wrGh th Hom rson in such man that i theePe me sublect to w°rkman's co side. I certrfY Data: emp following• late drawing on reverse Llok�ce of California." - aired in��ppp�aaactions- Comp do ust call for all re Title: licant m USE ONLY Area "''�,r FOR DE4ARTMENT pate r ed X pat x , FVnal lnspecfron by ` ted by pate Application Accepted } ❑TrecY 835- Stk., CA 9520 Pit or Grout Inspection by ❑ Manteca 823-7104 }iazelton Ave., P.O. Box 2009 t, mens: 36g-3621 ices}601 E• Additional Com ❑ Lodi lth PermrtlSery PERMIT N 46g_678} ental Viea PATE ' ❑ Stk all coQies t°: Environm RECE1V1rD 8y ApPVitant Return AMOUNT RENItTTEO CASK � —7� FEE AMOUNT OUF S ( 1 µ J INFO �� C��3