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<br /> Fy AN JOAOUIN LOCAL HEALTH DISTR,-i
<br /> iK1 E. HAZEL i ON AVE., STOCKTON, CA
<br /> Te!vphone 120-1-*6.6781
<br /> ry PERMIT EXPIRES 1 YEAR FROM DATE ISSUED
<br /> iCo:-,p;e:e ;:'1 T6p!;ca:E1
<br /> ;s'Vttr mi-de to:.'e San?cFcv�n II Hea!;h D's:'::l for a purl:1:o tenYru[t ard'w;eeta:l.I•e„c!l 1`c,6n dtsc,:td.Th s a:,1:rr::cn's
<br /> +•+ rate .::h Sin-'ca;:.:-.Cov.r.l O'c�r3',re III!z='er eh••aGt n' :EE2'Cr,•.ej]'pur.p and the ROLS and AeI c1:`•e S1,n Jm:C :n
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<br /> TYFE CF X% 1L;PU!•SP: ';E'Nw:LL,3` 1'rELL REEL,110ETAENT fJ DESTRUCTIO!d 0
<br /> FU6;P I.':$TALt4TtG.'f O Sl'S7E:1 REPA;R ❑ OTHER d
<br /> + GIST;,NCE TO':EAF•EST: SEPTIC TANK EEVI L!KES T I,Qj'-1 r DISPOSAL FCD. FACP.LME [�I
<br /> FOL'4`�CATI0!1 AC.=1CUL7UFE VI OTHEA V:ELL PlTS/SUM'S _
<br /> II.TE':GED USE TI FE OF 15'ElL FAIDELEM FEA CO',iSTPL'CTIO'J SPECIFICATIONS _
<br /> wq d Indus: ;en risl G OEeimm 0 Vameta Dia. e:t',e11 Eacevi:;on Gia,of%YallII
<br /> Casing
<br /> D D"'••!E:iuPrivi:e r"aLk O Tracy Type Cf Casing l3SPEC
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<br /> 1'i P,rtfic n O:�;er r.De:-.2 Gf;:h Cf G•e�t Seal Type of GIou1
<br /> I I iuiga::cn __. ,^:cv.Ct;b I 1 EI Surface SIlmlal!ed II
<br /> Repair .ro:k Diane L] Ty;e cf'P,;r.,a H P._ State Work pone—
<br /> V,'EII Cw.ruc:;on O V,I D*:P'-e:er SW'ng Ma'.v;al Itep!-Y1
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<br /> TYPE
<br /> F:tEr.'.'aar;allc'e1.,vES'I
<br /> TYPE OF SEPTIC 1'.I fiEw NSTALLATIOU I i F.EPAtF!ACGI7101 I I CESTF.UCTION 1 I Wo:tpt'C!11:em perr-6utd 4 pvtl:C ether is
<br /> avZ;!at:e v.;;I 2G}feet.) -
<br /> 1ns•c.c:eCn,tiill:Ent: FtS;:r.'•Ce—_ Cc:-•- c- C.
<br /> 6.- 1dumtEr of!!v;r.9 un'rs: a qtr cf ndiccros
<br /> Charac:cr cf ee;l:o a tep:h of 3!set: a:er:at'e depth
<br /> I cEPT:C TAI O 7:, .6:!g Caaaci:y to.Compar:men:s -
<br /> FXG,IR:AT'TENT PLT,0 h!t:had of OifpCsal
<br /> Fw D;s:ancn:o n<_aresl: Vic3 Fcur•,a:'cn Pioper.y Lire
<br /> LEACHING 11 0 :1a.S Ltn;:h c!..r,cs Total IcnS'%1aye
<br /> FILTER EED 0 D'e:3,re:o neaten: 4Y61 FeunI Property Lire
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<br /> SEEPAGE FITS I I cf;:a S;:e I:umter
<br /> {a S IIFS Ll Gs:ance:o neaiw. 1YH1 Feurta::on_ Ptopery Line
<br /> I3I OtSFOELL 70%'OS 0
<br /> t t I herety certify that I hate prt;ved:his a,p54WCn and that:I,••crk%I to dcne in a.cot;:ance vI San Jcagwn count;ordinances,stare la.vs,and
<br /> III and regula:;ons el the Stn icagu;n Local I?F2I:h D;sit;ct,
<br /> t Home owner or Gctnted agent's s;;nature ctri,:es:ha lo:!crr;na:"I cert;fy:Fit in t`e per4ormat•ce C1 the%I for which this Permit;s hfued,I-,W nct
<br /> EmplCy[my pEtfcn in such mart+as to'ecornit wtt;ect to,•.o:ktI cempersa:cn Laws e!,:9Vc;zr,;s."Contractor's h;Orig or sub•cer.;rac:;gip sigsmure
<br /> 1'e CerI the ICIfC,•.�ng:"I Cer"fyihag in il•,e ptrfotr•ance 0111 v:cik fer which thio perm`is hsutd,i 3:,311 EmpfCy persons aut;ttl to wCtt.ma�'s compensa• '
<br /> t;on laws c fCa:lctnia,"
<br /> I-+ Tho app!;carl mwt 'rr all rt�,u!t[d ins;Fcucr.s.Comp!e-,e tra,t;ng on re4ersa fide. / r
<br /> 9 Signed X -
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<br /> j �- 0R^EPkR7R4E'tT USE ONLY / f
<br /> Appl;CLI Acc'tp:ad try _�. �! Cato _ r ZS'115a Arca
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<br /> Pig tr trcvi Ir.'ftcticn ty Ca:! F;ral lnspc•tticn ty Ca:a
<br /> ` Add;:;Cr•al Cemmen:s:
<br /> 11 Sik <Cf E7El l7 io_i L7'.:ar.cca U3i:Ca f)Tu-cy F,:5 f; S
<br /> } 1;rar•g• A(I Ad tot is:o:Cr.v:rcr.r.tr.ai VtV%h lira„rEer.!cts 16 1 E. Hit.,0:cn Ate., P.O.$cs 2W3.S:k.,CA 5:-61
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