Laserfiche WebLink
r t_5 U <br /> /VOTE: —IA6 SERVICES SAN JOAQUIN COUNTY PUBLIC HEALTH S <br /> .1 ,RNV IRONMRNTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 APR 0 9 11.192 <br /> 1501L_ tom.(Z11467S. "Alo P 0 BOX 2099, STOCKTON, CA 95201 <br /> wAii5' 15 C-iNVIRONMENTAL HEALTH <br /> 7� vo(*� PMWIT EXPIRES 1 YEAILFROd DATE IBSUM E R M It T V I t <br /> CCC 0 f <br /> 15:bi (Complete in Triplicate) <br /> File- 0 P <br /> Applitil'tioli is herew nade,to San Joaquin County for a permit to construct and/or lnstau the work herein d4se./ited. This <br /> application it zede in eoeWlianat with San Joaquin County Ordinance No. 549 and 1862 " the Rules and Regulations of Ban <br /> Joaquin County Public A*&1tb Services. <br /> 17 Lj 7 <br /> It I 4Q <br /> job Address 2__ City/ <br /> Fd-Box- 7&07 <br /> D'eviriAl .51 PY7_4 4do"Is z sr RUrAceF.6tb __A/T07673 Phons <br /> Ow6st's Name A <br /> 4?33-ffZ 2- <br /> r209)Z1,8-7021 <br /> Feesr_�b 6 t2fc C'57 <br /> CtInItaclor iV'L&A6=4A_65 Acaress Ls e-4, 03 7,;1—/ -License No. 5-OW 57 Phohe <br /> TYPE OF WELL/PPMP-. Iq ­71 Out of service Weil 0 <br /> NEW WELL 0 WELL REPLACEMENT DESTRUCTION L <br /> PfjMP INSTALLATO 0 SYSTEM REPtIR 0 OT Eji 0 Monitoring Veli C3 <br /> DISTANCE TO NEAA I SEWER LINES M6 DISPOSAL Flw. PROP. LINE <br /> .�.EST: SEPTIC TAA <br /> S <br /> U <br /> FOUNDATION _j_'tL_ AGF41CVLTUAE WELL �� OTHER WELL_ PITS/ PS v <br /> INT���A TYPE OF WELL PROSLEM AREA CONSTRUCTION SPECIFICATIONS <br /> n industrjai C3 09 01fiGitom © Manteca 0ja. of Wait Excavation 7 77 Dix. of Wolf Cating <br /> y Specifications <br /> ClMv, <br /> 1"I Dilmestit/Privatib ,it Cj Trac Typo of Casing-_ T_V_ <br /> I'l Public I P 1-1 Delta Depth of Grout Seat Type of Gro <br /> I I Irrigation prox. 0 ce Soul Installad by <br /> Repair Work Donej 0 Typo of H.P. State work Dona <br /> yV%4 <br /> well Destruction 0! WON Diameter SoMaterial b Depth <br /> Depth, - Aler ale Depth <br /> TYPE OF SEPTIC WORK; NEW INSTALLATION I I RZIPOt AO�101 Ti I TRUCTION I I INo septic ryvern permitted if public &*war is <br /> available within 200 toot.1 <br /> Installation will terve: Residence— Commercial_ Other <br /> M Number of living!unite: — Number of bedrooms <br /> Chirsew of mil to 0 ospift of 3 last: —Water table depth <br /> SEPTIC TANK ; 0 Type/Mfg Capacity No. Compartments <br /> PKG, TREATMENT.PLIT.0 Method of Disposal <br /> Distance to Asersjt: Wall Foundation_ Property Line <br /> LEACHING LINE Ll No. III Length of lines Total tength/silt <br /> fj FILTER SED 0 Distance to r1satatt; Wall Foundation - Property Line <br /> D <br /> SEEPAGE PITS it Depth Suet Number <br /> SUMPS Ll DistafWA to nearest: Well Foundation— Property-Line <br /> DISPOSAL PONDS 0 <br /> 1 hersiby et mity that I hive prepared this appilcatton and that the work will be done In accordance with Son Joacluln courtly ordinances,state laws. and <br /> rufas and r*200066 of the San Jdaouift -v4-=t7 <br /> Home Owner or lice'Al;�agard's s,lignature obn;fies the following: "t cartity that in the performance of the work for which this permit is issued. I thall not <br /> employ any porsonin stich mainnor as to ba com subject to workmen's compensation laws of California.*'Contractor*1 hieing or sub-coarrectiAo signature <br /> Certifies the following: 'i Certify that in the porloement:6 of the Work for which thin poirenk is issued,I Shelf employ Persons subject to workMOn's Cbmpensa- <br /> tion laws of CalifatMa.41 <br /> Tht Applicsint must 41=6H ukald late drawing on reverse sloo. ff;z <br /> Signed X_ Title: Data: <br /> U <br /> PARTMENT USE ONLY <br /> Applitation Accopto by Orta At" <br /> Pit or Orout thip4cilon hJ Date Final Inspection3b Oata, <br /> A <br /> 1 — <br /> Additional C*n~ts:-M I/LZ 1A I- mt�_ M44 <br /> Applicant — Return all copies to: San Joaquin County Public health ServIceis <br /> Environmental Ilealth Permit/Servicee yf <br /> 446 N SAn JOAtluin, P 0 Box 2008, Stkn. CA 95201 V <br /> FES <br /> RECEIVEO Gy OATE PERMIT-NO.CASH <br /> INFO (AMOUNT OuE AMOUNT REMIT7 il) <br /> 4 1344 0499.I I sk W !2p-- <br />