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<br /> = 13 -12
<br /> L� =� APPLICATION FOR PERMIT
<br /> : ! i SAN JOAQUIN LOCAL HEALTH DISTRICT �
<br /> .t i6�1 E. HA2E:TpN AVE., 570CKT0'.I, CA
<br /> RECEIVEE
<br /> Te,ephone IXG) -E6.67St
<br /> PERNPIT EXPIRES 1 YEAR FROM DATE ISSUED AUG
<br /> Xomptcte in TlipFca*,e) EN`'IRtC}�'�IrrtNtTA .Tff
<br /> Appticatipn is hr.t^y made Io:'e SLn JCtcvn Local Heai:n C;:t,;ct tct a:tacit 10 cOr::Uucl an^_'rr iceta�l t!•e,+r�tl7•L•�(4iLi{•f �{ ct:icn s
<br /> M..aCe in co r:ril.ar,ce,,;:h Sam:Z,C-;I C.,.n.rr.v-,�,.r,znee No.`_-9'^r se.,�ge ar';d.,�E::cr.,.11 and J-e R„ILI and Rty.U':hcrs et the V.dcaqu;n
<br /> Local l<e aL'h Drt:ucl.
<br /> 2651 S- airport 11a} 5tcckton Lot s _ F!.5
<br /> .lob Acd-c!s - Ci:t, 5:.,e
<br /> Rainbo Baking Co. 3226 :-'0n,r9crerY, factor C oG]/456-_S53
<br /> OwnL•r's latae ACdri Ss r one ,
<br /> R." v
<br /> Anderson $ 64495 °lu" 7&6- 888
<br /> > cnsrxclor OeCt wr]llli>r��GR 2�1c'-:tss 631 Co,T+nerce CL .E=3 ictn_e ;,,5 r'r.a c_
<br /> TYPE OF V:TLLlPO4P: :CEI:'1'.FSL q 1vFLL FEPLACEr,!F!4T ❑ DESTRI CT IGIQ ❑
<br /> 4
<br /> Puvi, .';ST LLATrOy q Sys• E%j REFAIR q OTHER E i OTTitGCinq --r
<br /> DISTANCE 70 t;EA REST: SEPTIC TASE11'FR LIt;FS - 106 L'1SPCISAL FLD. PROP.LINE �25'
<br /> FOL-.0ATiON ACRICULTCF.E DELL CTHFR WELL - 1!)rl�asisumps _—
<br /> iNTENDED USE TV'IjE CF WELL FFCELEtA ATEA COk>TRLtCTIC'J SP:CIFiCaTlO!;S
<br /> { L7 Industrial L Dien Ec::em G I,+an:Boa Dia.eI 1Ytll Eatzvk iGn �— Dia.of V.ell Casing 2
<br /> Q Dcmtstc+Pri,a:e G,a,el Pack q Tracy Type cl Casing PVS Sch 40 Spec;GC2;T0rs GE-TG nt.
<br /> -- 1-1 P„blic IT O:hcf I'1 Dtha Depth of Gto�t Sea! 25' Type of Gra:rt UC11 Cn1 t
<br /> 1 f IrrFgaslon ]S'A;•:roll Ctp;t i Fts:err: Suf'.ace..`_'til Installed t1 !r emi a
<br /> Repair 14'ofk Done U Tt:e of Rump H.P. ::'otk Done
<br /> s"all Destruction l','ea --e:er Saat:ng f.4atwizl Rcp 5:0
<br /> *
<br /> Monitoring D±;:h F,,:Ef!!ettual tHefck,E4'I
<br /> TYFE OF SEFTIC lS'ORK: r+EW tt:STALU TIGN I I PEPAiRrAD0171ON I I CESTRUC TION 11 11.o scpT.st=ltrn prtn'i:ce,if P�,bl;e Eener is
<br /> ava,!abtc v:i;`in 2Cr3!ttl.l
<br /> - Inslatlalien wkll sen.e: Fe5;.cnce_ Ccmrneic'Ll—, O:f:tf• _,�
<br /> number of liv:rrg union.. !;cmtcr C}
<br /> �:harac:er of soil te.•a dipth of 3:oat:_ — —Waier:ab:e depth• .r-___
<br /> SEPTIC TANK q 7x;e:".!'g Capaci:y . .'.'J.Cornparm=_n;s —
<br /> PKG.TREATMENT FLT.0 1,!e:hCG of Disposal _
<br /> ^� Di: ar.ce to newest: L:'ta Fcurlez::en Picper.y Line
<br /> ' LEACHING LINE C1 .'•'7. 8 Length of lines ^ A Tod leng:hls'ca _—�
<br /> r., FILTER EED Cl Vvtnce 10 nta•.tel,- Y:e:l Foundation Properly Line
<br /> l.e SEEF> %'Z P1-S i I De-,;b Sire .:umber
<br /> _UMFS Cf Dit:ance to nearest: tVtl1 Foundation_ Property Line_
<br /> DISPOSAL PONDS C7
<br /> I hereby ctn fy Ihrl I have p:epa'tif this zppfca;idn and that
<br /> .he+work swill be done in accerdtnce,+d:h San Joaquin county a•dinsncf S.slate lavas,and
<br /> i rules and iegulaf>ur.s of the fan Jcaquin Local Health 041f$l.
<br /> rrs Rome oxer or l.censed agent's s:gnaiuta cen lits the folle,ving:"I certify that in the performance of the work for which Ihts perrnit is issued,I O..ill not
<br /> employ any person in such rarawr as to beco,-.e subjecl to tv9rlman's compensation laws of CtWomia."Contractor's hiring el sub-coniucting sigr,atwo
<br /> Certifies the fclleriing:"I cer..fy:t.;in:he perfwr.iance of the wCrk ler which this p4rml:is by ed,10611 emptty persons subitcl:d workmart's camstnsa-
<br /> tion laws of Cal,fornia,"
<br /> yr The applicant must calr all ttqu•red'r.srtc:!ons.Complete dra,-.ing on ftvtrsa side�
<br /> Signed X / ,f Titre:—_ r?)V "1$� Date: ._
<br /> I �
<br /> FOR DUARTME!iT USE ONLY 1 r r
<br /> i.. AppCca::on Accepted by i! ' -- Date� .___.; 1 Aft
<br /> 1`4 or Grout Ir.s tcticn b
<br /> F Y --� `^• DYs • Final Insp�c:ion by Dale
<br /> . .. __ - `"•. '.dd'nior+at CemmeNs: __ _�,,,,,`_ _—�
<br /> J Stk 465.6751 a tc-i 3C9•.EiS 10 4ean:ecs 523?765 ❑ Tracy Fv5 6355
<br /> AppKCan;• Return aft cop:ts:a:Fr.viwr.mtr,:kl Hna!th Pe miri£t+.lcts ;671 E. H4.011on Ase.,P O.eos 2f9, 5:k„ CA t3 01
<br /> IrfO 'tIOL':7 G':F .bOn.NT i10EL
<br /> FI6Lr:ID EY Ca7E� s
<br /> UE, :�UC � o� � �
<br /> err c,�- r
<br /> IMP TVM MTE Hca
<br /> 0MITIM OF ME OWGIN& .:
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