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APPLICATION FOR PERMIT 4L1 <br /> SAN JOAQUIN LOCAL-.HEALTH DISTRICT <br /> 1601,E. HAZELTON AVE.-; STOCKTON, CA <br /> Te,lephone 1209)A66-6781 <br /> PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> t {Complete -Triplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described.This application is,.. <br /> madb in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well pu"mp and the Rules and Regulations of the San'Joaquin <br /> Local Heilth District.,%f,,.j.:, <br /> Job Address 2071 E. BRADFORD city STOCKTON- Lot Size PM <br /> MRS.- HALLMARK re-.. 2071 8's­BRADFORD- <br /> Owne <br /> Owner's Name Add s s Phone <br /> -Contract ETTER PLBG. CO,_IM,oss -1035 S. AURORA ST_,_License No. 202228 Phone 463-1706 <br /> TYPE OF WELL/PUMP: NEW WELL 0 WELL REPLACEMENT 0 DESTRUCTION El <br /> PUMP INSTALLATION 11 SYSTEM REPAIR El OTHER El <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLb._ PRO?. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> L1 Industrial El Open Bottom El Manteca Dia. of Well Excavation Dia. of Well Casing <br /> 0 Domestic/Private 0 Gravel Pack L1 Tracy Type of Casing Specifications <br /> 0 Public 0 Other F-1 Detta Depth of Grout Sea] Type of Grout <br /> El Irrigation --Approx. Depth 71 Eastern Surface Seat Installed by <br /> Repair Work Done—D—Type of Pump,—, H.P., State Work Done <br /> Well Destruction 12 Well Diameter Seating Material (top 50'1 <br /> Depth Filter Material (Below 501 7' <br /> TYPE OF SEPTIC WORK; NEW INSTALLATION El REPAIR/ADDITION El DESTRUCTION No septic system permitted if public sewer is <br /> available within 200 feet.) <br /> Installation will serve::..Residence Commercial— Other <br /> Number of living units;— Number of bedr6oms. <br /> m Character of soil toa depth of 3 feet: Water table depth <br /> SEPTIC TANK L Type/Mfg Capacity— No. Compartments <br /> PKG. TREATMENT PLT. 0 Method of Disposal <br /> Distance to.nearest:'. Well Foundation Property Line <br /> LEACHING LINE CI No. & Length of lines T61 length/size <br /> FILTER BED LJ Distance to nearest: Well F6undaltion Property Line <br /> SEEPAGE PITS CI Depth 'Size Number <br /> SUMPS = 0 Distance to nearest: well Foundationr, : Property Line + <br /> _DISPOSAL PONDS El 1. "1 <br /> I hereby certify that I have prepared this application and that the Work Will be clolne'in accordance with SanJoaquincounty ordinances, state laws, and <br /> rules and regulations of the San-Joaquin Local Health District. <br /> Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not <br /> employ any person in such manner as to become subject to workmain'goorripensatioil Iaiwsof_Ca_Iifo'r_nia'."Contractor's hiring or sub-contracting signature <br /> certifies the following: "I certify that in the performance of the work for which this permit is issued,I shall employ persons subject to workman's compensa- <br /> tion laws of California. <br /> The applic4fnNmust c all f or all <br /> juired inspections. Complete drawing on reverse side. <br /> Signed X Title: PRESIDENT Date: 7/20/87 <br /> FOR DEPARTMENT USE ONLY <br /> Application Accepted by Date <br /> L C) Area <br /> Pit or Grout Inspection Date Final Inspection by Date <br /> Additional Comments. <br /> El Stk 466-6781 U Lodi 369-3621 0 Manteca 823-7104: 0 Tracy 835-M <br /> Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 <br /> FEE AMOUNT DUE AMOUNT REMITTED CK H RECEIVED BY '-DATE PERMIT"NO. <br /> C <br /> INFO <br /> + EH 13-24 IREV.I/a 5) <br /> EH 14-26 <br />