Laserfiche WebLink
APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZE:i ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISCIIED <br /> (Complete in Triplicate) <br /> Appfcation i^hereby made to tho San Joaquin Local Health Dhtric!for a perm.#to construct and/or rntiall the worw harder deecrihnd. This apoRc~a <br /> made in comps• :e with San Joaquin County Ordinance No.549 for owwage or No 1982 for%%OilI4rump anrt the Fuld and Rogutatutne at this,San JoaDu-t <br /> Local Healt:r Districts �7 /� p� <br /> Job AddrOSa _3>:Q�J7��I , I f�L1J — _--- aw-4rRr�/-"�,-(-�,LM Sits <br /> Owner'^ Name (.t�Lt Address __t_3_�3 �S.1'o_�l �t �OOPtxww �W?� <br /> nr <br /> 1. 3 /I-fl.- . _Lkeese No.-----PhO" _�IF! fA3 <br /> TYPE OF WELL/PUMP: NEW WELL I I WELL REPLACEMENT 1-1 DESTRUCTION U <br /> PUMP INSTALLATION I I SYSTEM REPAIR I7 OTHER 11 <br /> DISTANCE TO NEAREST: SEPTIC TANK -_-__ SEWEn t INES .__- nmPOSAL FLO PAM' LINE _ <br /> —^ FOUNDATION _AGRICULTURE WELL .-_ OTHER WELL__ ____ MTS/SUMPS <br /> INTENDEn USE TYPE Of WELL PROBLEM AREA CONSTRUCTION SPfC1fICAT10NS- <br /> Industrial --- 'I Open Bottom t 1 Manteca Dia. of Weil E.cavotlon^ -, Dim of~Cawng <br /> Domestic/Private 1-1 Gravel Park t 1 Tracy Type of Comm <br /> Public ❑ Other U Deho Depth of Grout SIU N <br /> Irrigation ---Approx. Depth 13 Eastern Surface SIU 1 1 fsy <br /> Repair Work Done U Type of Pump -- H.P. _ __._ State VVOA D/ttte U <br /> Well Destruction 17 Well Diameter _ y_ Seabtg MatWW flop 609 <br /> nth--- ---- <br /> Filler Material Ma'am 609 _ \^ <br /> - -------- ---- � <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION— REPAIR/!•I;al'TfUN : DESTRLICT [1 140 Mere system Pattnl R pubic seww w <br /> / `f A" ovslleAle within 2W feet 1 <br /> Installation will serva: R donee _VOther,.,,_ COrrvnsrcral! Other, M LI(` I •• <br /> Number of Hving units .. Number bed, s, _ <br /> f <br /> Character o1 sod to a depth of 7 feet �� LOA ^ Ovate.rabA.da0f*7D SEPTIC TANK Type/Mfg -�Q�-..1 ,(tl 'lTdfiys.a.asmrltr- ���(�__ No Ccettoatm.nts l n <br /> PKG. TREATMENT PLT.( ' Method of D"M r <br /> r , <br /> Distance to nwesh [�WeN. fourrlat+en -qP*opaty I. <br /> LEACHING LINE 101'No. 6 Langth M Innes la/ O Tog)bfg1A/UN— � <br /> 4 <br /> 16 <br /> FILTER BED Outanro to naerNr WIN_�.[( __ FOorldslbn 1'toelMh awte <br /> SEEPAGE PITS D �th --___-_ ___—:ilA_ _X <br /> a� _�OX-._�A 1 __� N1l%Mit <br /> SUMPS P Dbtance to rwmreet W"j0-a, lieu latowin_10 Pratt-,y - <br /> OISPOSAI PONDS <br /> I hereby cert,fv that 1 have prepared this appl•catrOn and that the wort, wrtl h.dorm n acco.Aarke with San Jctapuwt county Ordamnce% *fate laws, and <br /> rules and redulatiorn of the San Joaquin Local Hearth District. <br /> aiwrM Owner of licensed agent's eVnstute comt,0e the fn%Ovwrq "I cwtAv Nut in rhe parforr%an+a to itm worn for wtwtt Mw twr.vt w geuarf. I"not <br /> employ any person in such manner a%to becorrm sut+fact to vworl*man's c%VrKmrwatK+n isws of C*Wcwrw"Contt%rtw's hw"Or outs contrarcte.p"One"" <br /> certifies the follow+ng. "I certify that M the performance of the woo,for wt-ch the rrennt in assood.1 alias ern0"persons wrblsct to wo, roan's OOrnpary*e <br /> tK+n law%Of CabfOrnq" <br /> The applicant must call for NI requi insttekvn" s Complete drev'VV on reveres sods //�//♦ <br /> Sipnad x ,y - - -- Tiles -- <br /> _ FOR DEPART'MSNT USE ONLY <br /> Application Accepiwt t,� __. --o__ __ __--�y_-/T- - _ _ Date A _ Ares <br /> Pis or Grout Intpecrion by _ ��"\�`_ Dols 1 et Final fnspwb" by <br /> AddrtK.nal Cnmmants — _ *L_f -- <br /> Std 4M-1;781 (I Lodi 3%.W1 Manteca 823 7104 Tracy &11pd <br /> Apfrricant - Rahrrn all copra*to: Environments; Haahh Pemet/Servoces 111D1 E. Hazelton Ave_ P.O. Soil 2000, Stk., CA 96201 <br /> ffE AMOUNT DUE AMOUNT REMITTED �— RFCF"D Ily DATE ►ERM:T <br /> IW O 40CASIr L <br />