|
��}r
<br /> x: Y i t e :v..k >.•iK.! ?,l,; t ?':e Ar ., rs ss s, ' r rtR�
<br /> a },
<br /> y� �h ate{ i �.• i+
<br /> ��tir r rn r-- x ,, -,� + r-. Y <e k✓r�r 5.+r i `�.v - -i
<br /> lVAYL
<br /> �PERME7 �� s::, s ��,`�rY ��. ��
<br /> � I .SAN JDAQU-Irslr �,Ff
<br /> OCAEALTH DIS RIOT ag ' #r r s :, � j.'. ,
<br /> r X 1607E HAZELTON AVE STOCKTON�SCA
<br /> 46 y d ! 1yrL i=�,r t r Ian F i i Y S �-r R7' t4i ,C r a '�;f7�F' •'s `
<br /> hn �t rt-3 r' y j yTelephone 12093 4fi6-6781-: r � iv wD > S y ifrYiyprb
<br /> y rG PERI11fIT.EXPIREStIYEAR FAOIVI:DATEt�YI$SUED{ � Y�
<br /> r s
<br /> t* }v dei �,ti' ,y.;a .y.,° `riGrl`Ipl@tB*Irl RTriplicate S4� 'f
<br /> '.t , fIi.�'!,1 cIv1 i � ,1..,l.., r �, - sY .,<�; .i, f`: i < 1 u. y
<br /> AppllCatlon is hereby made to the,Sen Joaquin Local Health Dlstritt for'a'perrnit to aonetruct'endlar lnetail the work herairf� �Tftia
<br /> �msda{n oornpl]ance with fan Joaquin County Ordinance No 549 for Sewage or No 7862 for well/ trmp and the RVfes and Reg+ill,ii i ofrtha
<br /> a+ i r•� x S r ps .1rh ,{v.-- 2 +E { t dr. .. r +L' ¢5 t ,I3a• .,t, � t',r'� T
<br /> � Loeai Heaith District 3�W�4 a+ IrY r sw r '- a o s 5 sr w u""T ,
<br /> � 'w; aF dil. 4 u'� °Y���N 'a� d C"�yj l;:t'� d'b �1,' r�.l C,`3° '?•�'t -4v.�F Is. IY',� 5 r. �a�. +A,a�P ���s✓rt4� n lI `y}y+� -
<br /> q'' �r.�,r'i`ic,
<br /> tJOb AddressWwrh
<br /> 1 ,r r7 �fir ,n "��"#. {.dhs� 4 ,�4r ',, r I(Fl;'._k^I + M ,rra _Y .,,'..I� #v.iYrryh3t t,rc .t$ •c b,,�. Sit �'a�`. RY"'" w.'��, r
<br /> rs�jOwne
<br /> 'S'Name tQ�f/�y Y/M- Adckass IAX t' 3
<br /> ZZ
<br /> :i• =i(9'+^t d' ,Y ro 5 xy�', r r
<br /> .;z..s ``y.-,.
<br /> I}aE �ontr ctor I ��j,; Addressa �D VDd� /10A�eY � L�ce�se No ' ���I Phone° r +
<br /> f E"ICiF WELL/PUI4lP f a,; I' r NI:W WELL 0 3 4 WELL,REPLACEMENT3❑,� DESTRUCTION-C3�r
<br /> y jit ( Y? x PUMP INSTAL LS4TION,❑ - SYSTEM REPAIR ❑. ' kd�0711ER C] { a
<br /> 1• kOyy �' ,� Frr
<br /> STANCE T4 NEAREST+SEPTIC TANK` ' ` SEWER LINES# 4 ;bISPOSAL FLD = Plfl LINEr�� 1'
<br /> „'FOUMD4TIOiV; �\AGAICULTbiii WELL. -eQ71�ERsWELL "`�T't "PITSISUMPS fi s
<br /> r 9h.rb 4}¢41,''"w5• ^y �r 4 `._
<br /> 3rM n INTENDED USE rk = 'TYPE OF WELL
<br /> PROBLEM Ar CON57FiUGTIt]hi`'SPECIFICATiONS ; -y P r
<br /> �sRC7 Indt Stnal" �{� " ❑Open Bo ora 7, Manteea' 9r��Dla of Well E>tcevetton F s Ola Yofell Caiirt :
<br /> ❑rOo�nestie/Private � ❑Gravel Patk � ,fl.Trecy
<br /> T y'. I {Y+'<4 4 I w.a T Of GrOlrt €ta sY`
<br /> a ❑Pub1EC r}Sir p';C 4 ❑ Qfnar,7 s 3.C]_Ds1ta , Depth of Grou!$cal
<br /> a2lorii?�',�.��' a ^+�i `�lAppro Depth ❑ Eastorn , �s�f Surface Seal lnstafltd�y�Y
<br /> goti�q - J( I t i 4.
<br /> Repa�'fr�Jyork�Done �,❑" Type of Pu P ° - rk,l7�tts •
<br /> t 1 'i 4Yh o' I rI 3 '4n y
<br /> Welt Deatrutt#ond = ❑ WeII Diemet�r+, Sealing Material Itop:60
<br /> 14laterialF{Below�60�1-7 ass+ ,;,'_ � �,;�� y;Y '+�Grt.`;tf+es• sr�."
<br /> TYPE OF SEPTIC WORK i NEW INSTALLATION❑ REPAIR/ADDITION 1C�DESTRUCTION❑t(No seotic systOWL rmlttttdrlf pt+blleFsav(iet
<br /> ......., �'
<br /> ,¢ $ u ^r"ryr i ia'
<br /> Installatlon xnik rve cc tRasldence f rp Commercial r ' OtherJ y
<br /> be�of I(ving irnrts�t� Number of bad Dome � � � a
<br /> ••f -' i - + *'`s;o-e �+ 4 e3"'ar'a-� tile` 'k'
<br /> z� + �i Cha Star of son o a depth of 3 feet-' � 1 Water table ih
<br /> rrl SEPYIC ti7ANK ❑!Type/Mfg" a CeCYty{ it No SCOt7tparimantaa
<br /> �P.KG �REATMENT;PLT ❑
<br /> '�' g:.. r L t F4 �� .'i4T � !� i F1 r ��4 +i s L-,-'.3'Y�.t ,�t� f rA' l r7 r+,iuP��,7c�,�r}.[>)i'Y• ��"-s FA�'"F� a
<br /> pistance td nearest We41 Founn Property LEne
<br /> bra �,d�3'`��"2' < r$ �rF r I r�''.i. f I Y #'� @.•_�' ¢ a ��,r r'` ���3.l2jat'r �,`�'�°r r`a�''r. '�s'( s
<br /> ` .1E `"£"
<br /> z -No &Len th of lines' / S'o x Total length6slze
<br /> rLEAC
<br /> ING
<br /> gil x}+°_
<br /> FILTE r�ED pis s?r G]It Distance to neereat Wall _ Foundation �S
<br /> Property tLtne
<br /> ¢ .I 'e1✓'li: C k, 3,{ i 's'tri ,,x
<br /> `,14.`cy4x v r �.
<br /> L SEEP�GEfiPIT^�+�G�r +G C]% DBpth rF' J�� C Slze y ar r/1• k
<br /> mum
<br /> i4 ` z x t
<br /> Y.Y, J'� kr ,�e s w r ♦e = r S-* �+s•t 6 "`•�
<br /> ° ' '171atance to nearest i Well`i Four+datlon l Ploperty�Ene ��
<br /> s=519MP %4 � Y , � asrk
<br /> ` �•w.uat:r< ;iA jart't ,,,..; #. �t.., ryx' �riS sif v{"
<br /> DISPO A�PODS ., .r❑. ., :. i r:x ': � ` . Fr I �.
<br /> dh 1
<br /> i Irherei yc�Klt -thai l have prepared kthls;appliCetron and that the work wr11 bB done in accordance with Sartlrloa`i�ultr Cou rdirtance�
<br /> r ;rutes"a �regulationaof,the SarirJoaqu3n Losat;Health,.Distrlctr re i �.r. : 4:,.Y ;;,•1.. ,r 3 �" ;xr �¢ ` Gr
<br /> Home, wrier.�fr:Acerrised agerrt,s iigneture'certlfies;the lollowing d I C_9rtHy that_ln the•parfoimance of;the wor�cy�oGwh[�Tt ie m)h tsr .r.i
<br /> kv+�emplay any piaon in"such manrter ae to become;aublect to workmen a oompensetion laws of,California GtlntreCtors hirl sob contlettl' �i9neG[r�i
<br /> z oertlfies thy follo�virt� ;I certify that in the performance of the work for,whlch this permit h lasoed E sluli employ persons tsubJ t to workma"n'a.
<br /> tion 191�s of;'Callfomia`i4°y f i,'3�,'y r' •1�s j, .ar 3 " r 's F¢ µ �S, w a
<br /> rp,.x, vl'
<br /> Thea leant m zst car foell'requlrad lnspattlons Complete drawing on reverse side S -: i 'r k �+ a
<br /> y f -aW `5,{- r ft
<br /> 'd,+�`i r s
<br /> pfN{ ¢lf Mr r r >r t t r¢- r a i M;.r r • a s.; k r Ldn'Sl> '.^y„� .
<br /> IRK�t ski'• fi ,x 1 �1. Olt DEPARTMENT USE ONLY. r u n Yfi{+g n
<br /> " 'r 1>_'.. r T ,^,,r t' -/'•�- t 4"`r a,j}e°} ;d Sq .i- .r-
<br /> ppllcaticnF�ccepteyd by Datey r A
<br /> "s ,.*yy-LIF'I 'c�' >;J^,C ,
<br /> i n Pk or GrouteNpectfon by r Y L Data Fina!InspettiOn by d a D {yy U;G
<br /> b dt:Additional Comments ri r .,'r s x4 S s¢A� i s :r
<br /> � ;. � ❑ Stk '4666787 : ❑ L s s, 1 ❑'fiMtteu' 8237104 y ❑':Traey f,835K63t36�L+c rs a ;a�t f�1yhc w i
<br /> y . o x
<br /> r j Applicant Return ail COPIea to Environmental Health eitisl!/5ervtcea 7601E Hazelton Ave P O'box 2009;;Stk..-,CA;
<br /> { - ro_ r- � { -,: P ¢.--:e f vk a i y H� .� i '� ;�a�e�r='' x ��'�;>•t{ 5'.taf��'¢ �+�x:ks�� i#{ �'L�r}��� �-s�
<br /> r� .'tee.i+,��ro5.,.','Y k`G � d, r-t x- '�S r"r-i•` tir.,- .r"' 3.s w �r•h� �-h r. •a,+.� s � ��� �'4`'f�1
<br /> -7 S 3y1� �, y. I:..- M �- a :1'.. � R7 �� �;.. 'X'i- ,tv r - -1 •: a5 s s,, fx P '-'>, �y,{�� �
<br /> FEE +;
<br /> f AMOUNT DUE AMOUNT REMITI ED CASH +RECEIVED 9Y 3 DATE �' PERMIT'NOxgr
<br /> '^ u INi,K §1 r^ t•»`s INFO!
<br /> 4t EFf 73.24[AEW 1/ 1 a s
<br /> tt va
<br /> Al
<br /> •i
<br /> �SL;EF'r� �.Grdi�t otic ?.,z lr'�hi..c-.nMti cr} � , ^,� r:, c• P^ + 4.,s N s_'� �3t',i g, + 'r'i_.:r£� x'�rr[{ r'r,�,v.��r,�,.,
<br /> _ r.:• �',-�'L�4 i a r v,�v y,�I„ f�g�¢ �M r'�w 97{�laid w >R39Yk7S��? �- Y�I�{y Ire
<br /> w`'Cfi¢uauu �9 { 356hin.�1'hf�411+ t7!, i !a ,7 s
<br /> *yrs,at,rha ; iri'� r v� '�. w c a• -. #-�' p fr{ +"�-:rL ld a-.-r f,e 's. s�h�•fi5 vd „�i:M
<br /> W �6«+t;�+'y ', v,,.'�1`k �� "• ��. A w,ny. �I�,,� tl �a^+..r-rtr I `. � r �. �y y '. i , r -r- �?•5,' r -R+`. ter?: �af�_ d>, ��•+�°y;�1�" �: �'.Y
<br /> . .r `�`r Y fir'. � a,7 � +�`� r� �. r�,y4s� �uF'- e �{ r �� Ei$+"�� 7, snn I ' -•`k7� �+�. r F a ' ,�s, - � r
<br /> 5
<br />
|