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APPLICAl10N FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT It l <br /> 1601 E. HAIELTON AVE., STOCKTON, CA L <br /> Telephone (209) 466-MI <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Appf-.atron is hereby made to the San Joaquin Local Health District for a pannit to construct and/or installl the work heroin described. This sppacaslun is <br /> mads in compliance with San Joaquin County Ordirtalee No.549 for t»wspe or No. 1862 for"1/pump and the Rubs she Rsgu1stir"of the San.lorquW <br /> Local Health DmIrict. c <br /> Job Addresti I –+• �(�� C Lot St» MM <br /> ownele Addrw <br /> 240Phone P <br /> h«,. <br /> ContractASL 6 <br /> ;Z' Addre[[ <br /> 9 -O <br /> Lkaft[a No. �Pftate f ! <br /> TYPE OF WELL/PUMP: NEW WELL D WELL Ri1&CEMENT'}O DESTRUCTION 0 <br /> _—� PUMP INSTALLATION O REPA►It 0 OTHER O <br /> DISTANCE TC NEAREST: SEPTIC TANK ...._ 'Sr <br /> LRM'!_ ' D13oOSAl FUD PROP. LINE <br /> FOUNDATION AGRICULfiAfE VME4L OTHER WELL PITS/SUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEMAREA CONSTRb6TJaW SPECIFIC/1TIONS <br /> O Industrial O Open tlonom O MW"" Dia. Of Well E da,of Wall C"m <br /> O Donrstic/Prlva s O rwavel Pack O Tracy Typo o/CaaMq � $oedits"we <br /> f'1 Public n Dow n Delta Dapth of Grant Sam Typs a Gratz <br /> I I Irrigation _Appror. Depth 1 I Eastern Surface SOW hrtsnad by <br /> Repair Work Done U Type of Pump _ M.P. Stab WN Do _ <br /> Well Destruction O Wen Olamew sea"Ilfbtatfal flop 60•) <br /> Depth fellow f1r) <br /> TYPE OF SEPTIC WORK: NEW MIST LLATXW 1 I REPAIR/A00ITIONi I DESTRUCTION Imo p pubic 1Nwer k � <br /> .t ►Mt.) <br /> Irnanlmtbn wiz MM: .� WnrMnM'CM,_ <br /> Nwrnba of kwnp unite: Nwnber of bottom,r <br /> Ctwww of so[m a depil of 3/set: Waver tabor <br /> r--4&#6C TANK Typo/Mfg Captlryr Nb.CaRpar+a <br /> PIM TREATMENT PLT,O ; hug <br /> Distance to nsl6w: Wen FMid1ptlort Probang Lina_ <br /> L44MNG LINE L1 No.i LwVfh of liras _Toth 1 <br /> Ir>yE(5 O sbsk <br /> Oktanca to es�raet: Well Fatrndatfon Pr4MW Lkw <br /> 4Abt PITS I I Depth - 1 gW Nwl*w <br /> sumos 1.1 DiVemos to n•:•••• ► FoundationDISPOSAL PONDS O <br /> 1 I73raby CWfhV nkat I haus prepared Mlle MWAcatlon and"W Ow wont WE be dor in accordrtee wkh San JOWOM cmmty ordkwnt,w stile YvN.aM. <br /> rums and regulatk•no of the San Joaquin Local Health Dktrkt. <br /> Horne owns or 11con in su h it mare sr aw to 10 oaitPlas the foiowing:•1 t WWW that N do perfor"lan e a the work for Wild this poem*k kamcL 1 d*j no <br /> ampby any person an such renew as co becortns wbPct to workman's eon ertaatbn rows of Crilorrtm.,,CORtraCIOr•a hiring«w+boontrsctYq dgnmwg <br /> cat <br /> cans ll t e C �.•,I certify that th <br /> in e pwfornrnoa a aha work for whiafhis n tpat III k issued,1 den ampmy r m welblact a workrylaWo oG <br /> rtOartaa <br /> TMapp7ca u t a for all tsqubsd brpeedw <br /> ContplsN d►eMM1/an rouses aide. <br /> S*rd Tft: pets 9!QOp <br /> -e7 n <br /> POR DEPARTMENT Un ONLY ,[T� <br /> 040111blItlon Accepted by Doc. �— V —�2 Awa 3 <br /> PR or Grout I `– <br /> �__ ''=„ �M!�o•euon Dasa <br /> Addltlonal Carwrients: n <br /> O Sts +116.67111 O Lodi 3Eli 3VI ❑ Mtteoa x117104 O Tracy /1364M6 } <br /> AmNcwn- Petaml all copies to: Emkorvtrnul Heslth Pal a/SerAm Hill .Hau ton Ave, P.O.*aEll..tA mm <br /> 17 <br /> itE AMOUNT(>tl[ AtMONNT RkQMTT[D <br /> tMiO RaCE1V[p ay 11 lbA+1I RRkert /rep. <br /> .1M 11a1111eV. <br /> 11we1 <br /> ..t1�:A1ry, <br />