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<br /> APPLICATION F01? PF UN I T
<br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
<br /> a ENVIRON11K TAi, HEALTH DIVISION
<br /> 1601 F. IIAZFLTON AVE. , PliO'II{ (208)46$-3920
<br /> t-f P O BOX 200$ STOCKTON, CA 95201 f
<br /> Y-E 1IT F DRYS 1 YEAR
<br /> Cc�l Ict
<br /> ( P e in Triplicate) � I
<br /> AjrpllteLlor 1a htreby meth to Sen imqu!n County fora perctt to construe: nndior install the work herein descrlbel. Thla !
<br /> eppllcatloa III made 1n crxyliance vLtn San Joarruln Courty ordlnence No. 54; nus and 1662 ll the Ruleand Regulationa of Sen k
<br /> JoaruSn Couut•• °u51'.c Health Services. I
<br /> Job Address S1se/Acrengr
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<br /> Owners Nanw _�,iLM_.___EQszc'�Sl'P_S 1d�l.es.r .___. ��-S/� Phone . —.KLt+��
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<br /> vF Conlr,clor .X'. -EC •f_L-1S.—�A'r:rrss � : 5 GfG�- _Lrrn�e No: +� � ? e
<br /> _ _1 I r-fiS �Phone
<br /> TYPE 70LU'V%.PNEW'h'ELL WELL REP�ACE:'k'N1 errlce Yeli DES7pUCTIpN U WL of S ;
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<br /> P1,Wr INSTALLATION SrSTE`A REPAIR OTHER G Monitoring Well
<br /> DISTANCE 70 NEAREST, SEPTIC YANA SEWER LI`.EC ____— DISPOSAL fLD. _ PROP. LINE .....�_ x
<br /> FOVNDATION ALRICULTUE£'.YELI OTHER WELL _ PL.'S/SUMPS
<br /> INTENDED US.' TYPE OF V1FLL PRORLEN!ARFA CONSTRUCTION SPECIFICATIONS
<br /> i* ` L"1 Industrial -~—._ LJ Open Bottom L;Manteca Da at Welt E,cot-Alan .�
<br /> Du.of Well Casing
<br /> '1 t L1 Domesocepr;vate L:! Gravel Pack Iii Tracy T,Im of CAS.F -,�
<br /> a a r 1 l Pubf c f']Other paha Dfnln..t G:«n Sial _._ w Type of Coco S
<br /> . ':"a1•-
<br /> I !IrriNahof, ._v APprol.. Depth i I Eas;en, Sur fare Seri lnvran.,l by o
<br /> Repair Work Done- LJ Type of'Pump H P. _ — Stare Work Gone
<br /> Well Detln°et.on E. %""elf r'iamllee __T_,_,_,�, Sefiling 1Mste;:a: A EI•-fit* M
<br /> *� Grp[,, T111er Material • '�pth -
<br /> - TYPE OF 6kPTI4_WOHK: NEW IN`,7ALLAII0J`4 I I HEPATHrALlilITIUN i''k SI OC IlOh a I (No sq•hc srelam permalsd d public fewer q
<br /> ava-;abra-,thin 200 rest.,
<br /> Inalaffarion wit see: Reserce!v Cammer[ur Dene,
<br /> rys
<br /> lJumrler of living unite:�.j_. N..rnber of bedrooms ._/,{.��• -
<br /> s' r Characta+of SOH to a depth or 7 roes: -Q�J/F Yater tabes Oepat
<br /> SEPTI,TANK C1 TYna-f,ffg +t,L..,. .—_—. Capacty_..�i QNa. CompartmentsTD
<br /> Pli TREATMENT Pt.T.C; r —• Iktrtfwd of Dispoul I
<br /> Di.lanea 10 neatest Well Foundation ytrti'L' Properly Line _J7z2 _Lr7-
<br /> �f 4' LEACHWG LIME Nt,, b Length of hits ,.—�, TOW lenilth/s+:e�.. C✓� F'T' - ;
<br /> ;I\ FILTER BED (: Disrance to nearest. Wall wFoundai cn,JQ. r' P•aParty Lina
<br /> {� a SE£PAG£PIT'S i ! Depth __„__ Sue
<br /> SclMPS L' Grs:arxe to nearut: Well _ FaundeHon.--„-_,--- olArty Lina Pf
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<br /> .. ti L7
<br /> DISPOSAL PONDS !
<br /> dZ `� I hereby<ertlry toll[t hays pill+e,60 ibis application ant}that the n—i -8 bb duf:C in acco,,ur,ce w,th San Joaquin Counly'Ordlna�[a's,stale larva,and =
<br /> rules and idovialiont of Ma e.511 Jna9uin Colln y ]
<br /> Horne owner of licensed elranl s Signature certifies the tdaOwlhsl: '1 Comdr!hat In thio pefluer,%an[9 of the work too Wf,i6h this permit is isssked.I shall n01 ,� {
<br /> rimploy any psrrmr,in such manner of to became subject to worYman'a corns.onrabwl isw5 of Calilorn.a,"Contrectof's hiring or suls-contracting signature § PJ
<br /> F
<br /> i comfies the fonuwit,g-"1 cartily trial in that performance of the work"Of which this Vow nvl Is issuaC.:shah enn"persons sutlect 1J wart fTLill s cM,pansa
<br /> tion laws of halitorngr.•' -
<br /> Thi epnticant must call for all lnuuu,n;lowectfons. Compiale drawing on iev'e:ae S,[ee. - -
<br /> L.I Signed k—.-_ C'i 7 G{� ..,_'7 _ T11b.
<br /> Date: �.
<br /> FOR DEPARTMENT USE ONLY
<br /> .Appliceuon Aeteptrsd by '5-.!�-----._—�.,. Dale_S !U Area _
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<br /> Pit or Gro+rt Inspection by ._...-.--�. —._ Dasa_ Fina;Inspeciion by�f- Dale
<br /> ,J v' ACA;tionaf CammanL: UIr� 7'sl..�c-- r�P-I r .r "S� yLot
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<br /> Ir Applicant - Return all coplea tn: flan r"oaqufa County Yubllc Rcalth
<br /> p `5 PF es,-Lnvitoa Health ?erral;5lryices
<br /> Servic
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<br /> 1601 1% Batelton Ave.. P O Box COQy, Stockton, CA 95201
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<br /> FEE AMOVflI Di/[ AMOVr�tT n[/.1riT{C fx s REC#IVED By �• .
<br /> INFO 1r CAS,( DATE PERA!!t'NO,
<br /> IN t1Ta IaN.+t•S'
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