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APPPCATION FOR PERMIT
<br /> V SAN JOA(ILJIN LOCAL PEAL"14 DISTRIC', 00 FY
<br /> '6U! F. HAZEL iON AVE., SIOCKTON, CA
<br /> PERWT EXPIRFS i YEAR FROM DATE ISSUED
<br /> alt,
<br /> Applirrlion is hereby math=to the S.111 Jnaquia L0001 H-IA0DIS16C.1 for -A'IVIIII'T It, install III(, t
<br /> woft,herein ties:rhea. This mp;r.ajlon5
<br /> made C0;-,4)IMo(:C With Stir)jo�quin C ......Y Urdwiancu No.rjq fur Sc,:j!.i or N-,): 1`iQ lw meal:pump rh,;R,du and Roji'da'oo"s of!hu San joaqupr,
<br /> Local District.
<br /> e
<br /> �? - /b-, -.-
<br /> i:V
<br /> Job A(IlleSs Lot Size P&I
<br /> i7_
<br /> dtfwsr
<br /> �it Y
<br /> 2�_41±"__
<br /> 7 1
<br /> TYPIC DF VIELLIPUMP: WE[-L "t 'WELL K.11 A.v DESIRUC'�IUN
<br /> PIAIFI INSTALLATION SYST DA RCUIA�R I I OTHER P1
<br /> DISTANClE TO'.)EAREST s[p-nC TANK SEWER LINES ()'.SfIOSAL FILD_ PROP. LINE
<br /> FOLTNI]ATIC)% AGRICULTUI71F VVFII, 0TI1FR WELI—_ PTS/SUMPS
<br /> R()RLFM Af',FA CCINSTRUCi!ON SPECIFICATIONS
<br /> INTE,'IDLD USE T Y P E 0�:V"E L. P
<br /> —tis i f_iaI j Manteca Lm of weli Exc,iv,iflor, Dig, of WC!!C
<br /> I", ino nen finzi 'r as�no
<br /> 'Dorrewic/Privmu 74f'(],avel Park f Tracy Type of
<br /> 1'1 Public F-I Oqh,,.r - I i Delta Dlq)T}) of G".,mit Si!jl. Type of G.,C)"I
<br /> Approx. Du I-,T T EASIL—) S...face S;_.dl Installed bv
<br /> Repair Work Done 1.1 Type of Pump ------------- INork 1)69�e
<br /> v—
<br /> -alin(
<br /> truciion I `.V,?.!; D;ameo SL
<br /> Wall Des I 'vlanma! !Ief, t)0'I
<br /> Depth Filler %mai,.'i;al (FIofclw 50'1
<br /> Tyf,E OF GVPTIC WORK: NEW INSTA(I.AlION 1 1 liI"f'f1IR,ADD-1I0rl 1 01:S llrIUCTION 1 1 114fw
<br /> o 5or 5VSutm peimawLI if public sewer is
<br /> avad,11fle witflin 20)luel.)
<br /> lnsmllatimt wil:servp: Re�irincn Commercial i r—'--__
<br /> �lumber of living units! ____ NUMN-F of 1;iudmorns
<br /> Chs.,jcler ot rO,T to a death of 3 tees tahle fial"tt'
<br /> SEPTIC TANK lypel"AIg No Conipartnifints
<br /> PKG. TREATMENT PLT.I'1 method of Disposal
<br /> Di_,,dn". to nearest: Wul� Foumlo0on Profict-ty Lino
<br /> LEACHING LINE 1-1 No. & Lenqth of lines Total
<br /> FILTER BEL 11 niStMICC 10 nearest: Wall Foundation Property Line
<br /> SEEPAGE PITS I I Depth Size
<br /> Number
<br /> Sull"s t I u
<br /> Di5!,,..i!:o to numest: welE P7op-aty Line
<br /> DISPOSAL PONDS FI
<br /> I hereby corlity Ilial I have p:epaFud this application and lhaj the work will t)oj dc)iw in accoidwice with Smi Joaquin county or&narices, state laws,
<br /> '
<br /> TU'CS and regOolions of lie San Joaquin
<br /> Local !Jeallil
<br /> tiorna ownlicenser or Igun!'s signature rorli!ius tho followinli:.'1 certify that in the f,orlorinance of the wmk for which this permit is issued,I shall not
<br /> arnploy any parson in fu irnanflai as to bacorna sishlat;i to wofkmari's compensation laws 0 California."Conlracwt's hiring or s,.lb-contracting signature
<br /> cari4i(,s tho following' ii b Y All in-.11to r1oirruince of Ilia vjoik to,which this pwro'r,is issued.I shail employ persons subject to workman's mmilrinsa.
<br /> lion li)-.vs o!C.aMnmi
<br /> The afjpticant must "j;iT I r(Iq;)ir +i5pecllon7jr C(?P1pl(?IL'drawing on toy
<br /> (ilia: {tato:
<br /> F()n DEPART/F"N L,SE NLY
<br /> Application Acceplud by Date Ama
<br /> Jectio'l fly
<br /> Grout In"PecTic.r. by LO
<br /> X
<br /> Dato ip':AL� Date Pit o TV
<br /> Final Insl
<br /> 61-f I
<br /> z-
<br /> AdJiVunal Comment... ,I--
<br /> E) sm 4&5-6731 Mrdi 369-3621 NI.nwocd 823-7104 1-3 Tracy
<br /> Appkanl R6tU1r-all CGPiOS IZ)� Environmental HoElth Permit/Services 1601 E. Hwulion Avej., P.0. Poti 2039, Stk., CA 99201
<br /> ANIGUNT DUt AM,)UNT QEfjjTr`j) B,eD PE"M 11'N0
<br /> C --)�--)
<br /> C-
<br /> 4.
<br /> Ell I 1 212
<br /> X.
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