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AP1 _ O PERMIT <br /> SAN JOA 10OC HMTH D1$'1`RICT <br /> 1601 E. H N AVE. ' 1N..CA <br /> ne 12081 <br /> PERMIT EXi MES,1 YEAR FROM DATE ISSUED <br /> ete in;Triplicsrta} <br /> Application is herr t r ,Sen Joaquin Local ` s permit to construct and/or t#�,work here ► °° � ° € to <br /> ��. tends In bompr lW "fit fot vel <br /> ter. <br /> Local Health §'4 f b .E' > t # ,� * , S,•; <br /> y <br /> t$tJ. �3.= <br /> Job Address M1s1 m e 1i, :r ,, City Lodi _ 'Lot Size <br /> L � <br /> Owner's Name idols <br /> Phone t <br /> Contractor's NamXAL &TEA DR i LL 1 NG License No.43421 S Phone632,-7932 <br /> TYPE OF WELL/PUMP: NEW WELL 9 WELL REPLACEMENT ❑ DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK "— SE)MR LINES 150' DISPOSAL FLD.""' PROP. LINE 100' <br /> FOUNDATION 150' AGWCULTURE WELL .-- OTHER WELL-------- PITS/SUMPS"" <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ❑ Industrial ❑ Open Bottom ❑ Mentere Dia. of Well Excavation Dia. of Well Casing 20 <br /> ❑ Domestic/Private I Gravel Pack ❑ Tracy Type of Casing 5116 Celrten Specifications <br /> I Public ❑ Other ❑ Delta Depth of Grout Seal 1 10 t Type of Grout 9 SaCk <br /> ❑ Irrigation A40'Approx. Depth ❑ Eastem surface Seal installed by CALWATER . INC, . <br /> Repair Work Done ❑ Type of Pump M.P. State Work Done <br /> Well Destruction ❑ Well Diameter Sealing Material (top 50') <br /> Depth 'fir Material(Below 501 <br /> TYPE OF SEPTIC WORK NEW INSTALLATION ❑- REPAiR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is <br /> n ._ available'withiri 20d feet.} <br /> Installation will serve: . Residence_,. Commercial_ Other <br /> Number of living units: Number of bedrooms <br /> Character of soil to a depth of 3 feat Water table depth <br /> SEPTIC TANK, ,Q,, Type/MfCapacity No..Compartments. <br /> PKG;TREATMENT PLT } - <br /> Metttiod of Disposal <br /> T Dbsftrx b: o' nrst Well Foundation— — = Property tine <br /> M <br /> �Af�iNG Uf�E <br /> � ''.'A"•} r �= �����a�i,i�1L.��� ,� r+"#�. r :�-� y...?' „�� •:.'� £�`e�'�" � � 3 kx k� �s ti r '+ ;•. <br /> - x k ': a� -5,h3 .p„� °;'7 tr "� w• ry 41 <br /> B i <br /> T <br /> 'mo-4 <br /> ;„� �� •tea y +�a" �.l `*t S -,.a .� <br /> Y,. <br />_ ' -,r .. - �< a`. :. _ „ .�'�. .,,.:"; „•...,y. ..tom ,. .. <br /> , <br /> � Ph <br /> }-� ��t�� I- '� Y��� { �{� p/�y�Ccr�� �' �yyy pY�y�N �.. � w k.: t * +4y •�. <br /> ,r:= C• 7" .. + ,tl__W_ 6,=! '4ar>`Alre.. +O BCOt ayi ret- {r� <br /> •t' .pig. Y.y. + SW*•^ ,. X17.'.x'h•^ * a., .yxa$..' r5 �1r �..+.,gro.k. 4- yy«.a,,.,, <br /> �•-F"5� °i �•`' `j`��` ,�•;p�` '95 ,�:"Mr` ,;�; # ,� ,k'rf�i'S6� }"-, '":}, '`i;.-Gr u: s tk' § , <br />