Laserfiche WebLink
s � <br /> SMN JOAQUIN LOCAL HEALTH DISTRICT <br /> .<. FOR OFFICE.US .`1601 E 'R zeltoa Ave , Stockton, Calif � H ''� <br /> r_ T?Iaptione (209);.466'6781 'F <br /> AI'PLICATiON:FOR-ir,LL CONSTRUCTION L'R PUMP PERMIT Pezmit fila w �.• <br /> «_ <br /> r THIS -PERMIT=EXPIRES.I­ EAR-: DATE ISSIIED ¢` Date IBeue _ -- <br /> fl <br /> t (Cotuplete <br /> `"Applitatiom`is hereby made to`the Saa Joaquin Local':Sealthr. Distr3ttta�c <br /> �andfar instal.[ <br /> lhe work::herein:described This.,applcationfis made itf tompleei oaRltria <br /> ;Cotuitp Ordinance No 1$6� aad:the les aad Regulations of.the;Saa JbaZacltl4 ci <br /> Ru <br /> l :JUWB 'ADDRESS 'LOCATION <br /> *Address <br /> 4.0 <br /> o't <br /> �' �C n iacCor. <br /> sHame. t.;r <br /> _ <br /> �'. .-", _ .rr .qtr��' i ar r kv•5� � K sem`•' ',�. <br /> STYPEOF WORK (Cht�3c} HEk'.WELL::�rJ. DEEPEN /� RECONDITION %7 D STRZSCxI <br /> / / f <br /> `w PUMP INSTALLATIDi+i PUMP REPAIR Pim REPLACEIIEpT <br /> 77. <br /> - <br /> " DISTANCE TO NEAREST SEPTIC'.TANK EWER;LWES., <br /> �� SEWAGE,DISPOSAL FIELD S-CE SPOOLISEEPAG <br /> PROPERTY LIi1E.:'� PRIVATE-DOMESTIC WELL'��`.'PUb-I&DMOSTICr <br /> .INTENDED <br /> USEL. TYPE:OR.,WELL°:' +=CONSTRUCTION;SPECLFICATI0W={ <br /> r Intrial Cable Tool Isis of:<WeII E <br /> omeatic/private Drilled t Dia. of ,Well Gearing y 3L s' i <br /> {rte 'Domestic/public Lir en >r Giige o£:Casif1 ' <br /> tat ionr �'1 Pack . Depth;cf Grout S � .x��-,ter_rm"= 8 "" �r <br /> s <br /> at `0. C:-.,.PxoAtectlon o!Rotary, Y` ;Type of rGrout <br /> '� ' sem¢`�Dispos"e14• ,`r � 50th�r •s Other Iiformatian'�`� ;, r M "' <br /> /.� fr <br /> �llS tauedf$ <br /> �".�r'}S'-� ! 4"; ;_ _F x•<+.. - r _ - f -�. sil <br /> x5:`PUID'�INSTALfATION � Contractor, a= � . �-� <br /> r k r Type : <br /> of Ptunp <br /> ..... <br /> REPLA� %�/ State Work Done <br /> �•Sr +--- r r - -'+ _+r , T '�" � R�� sir,av`"-�".3•..� - 'Fs r S` <br /> PilI3P�:REPAIR: /? State Work Rorie ` <br /> - - _ r <br /> LESTRUCTION:OF WEF.1. x WellDiameter a�_'. .,.. r S` ' z4pproxfmate D&p_&t <br /> e " , Deecribe Material`aad,Procedure �'` F' } c�_ <br /> I hereby agzee to comply with ail laws aad regulations of the San JoaQuia}F.ocal�HelthtL <br /> and the rState of Ca33foraia pertaining to ar regulating well coas�ru�tfor!�`��f�ttla�it�, S.'�. <br /> after'ca 7etion of work on anevi well r 1I will tuxnish the <br /> FTEI,L n LLERS REPOT of 'the Well.and uatify them before putting xhe�rae -ye` e- <br /> rfarma u is true to the st edge <br /> d b anlief ' �'� , •x <br /> - be sPl � s L WTr:T- CALL`rFOgrAFGR1OUT�Itd <br /> pSI�R 70 OTI;IC>`AND FINj R i <br /> } :r',> - <br /> $I <br /> PLAN.ON'REVBBSE. STDS Z -'3►`;'.`.� c _• `t �' <br /> h. FOTsDEPARTHENT F1SE ONLY �II <br /> APPLICATION:;ACCE:PT� BY ` r" -ate <br /> ADDITIOiL 5 1 4x «. <br /> :INSPECTION ,_ Ps' R III: FINAL INSPECTI ' <br /> _ INSPECTION BY DATE b INSPECTION BY` DATE; <br /> E'. 1426 ReY -t7k _- , ,; -. _ F •, �' ',5e _h 7 �-, Y� !l_`..�, `Y r ,T <br /> lig <br /> i�/ <br />