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r <br /> r r r ~^ <br /> SAN JOAQUIN COUW1-- PUBLIC HEALTH SIMVICES rr' <br /> 1 &QTYIB::� AL HBALTIT LIvISICPi !' ` <br />' 445 B SAN JOAQUIN, PHONE (209)468-3420 <br /> P O ''CX 2009, STCCXTOIV, CA 95201 <br /> L s^Asy , <br /> RMI"C 3RR9 1_ A C}LDAM ISSUED <br />' (Complete in Triplicate) <br /> @ � r ` <br /> g Applieatica to bereby ratio to San Jorqula County for a poroit to eonoerv.t and/or inatnll Us wrh baroln described. 'Elba <br /> { appl'tbtion la mttde in tw*llaneo rlth San Joaquin County Ordirtarico 110 349 and 1862 mid the Auloo and ReattlaticAS Of OW <br /> Joaquin County Public Hoalth Services <br />' Job Addrolo 6031 E. WATERLOO C,ry STOCKTON Lot size/Aerenae <br /> 0. <br /> SAME 95215 o�te 931-6831 <br /> owner's N AH1ALiA ALCALflE Address " <br /> NGACK PU'4P CO. 4500 E. FRE?dGNT ST 504513 948-8817 <br />' Cantrattar Address�{.[�y�yT.j.}jy License No Photts <br /> ' TYPE OF WELWPUMP NEW WELL 0 WELL REPLACEMENT n DESTAUCTION Cl Out or SerYlee Neta Neta <br /> PUMP INSTALLATIOY d SYSTEM REPAIR 0 OTHER C NO°itOrI'S mall 0 <br /> DISTANCE TO NEAREST SEPTIC TAMC SEW:R LINES RISPOSAL FLD PROP LINE <br /> FOUNDATION` AGRICULTURE WELL r_ OTHEA WELL PITSJSUMPS <br /> INTENDED USE TYPE OF WELL r PROBLEM AREA CONSTRUCTION SPECIFICATIONS r 5 C t <br /> 0 Induatrre! ❑Dow Bottom 0 Mantoca Dm of Wets Excavation Ola of Wer Car" ° <br /> - IN Domasit,01"avow ❑G"w pw 0 Tracy Type ori Cawng Spazdic <br /> Dc1ta Oepth of Grout S <br /> Other ub+"e `i f'[ aa1 Type o!Gres► y-"'. �'�e � a` <br /> 1 I P -r <br />' - X11 <br /> I I Invalmn ....-.Approx Depth I i Easton Surface Sand Instasad by <br /> Rgpair w"Doris 0 typo of Pump SUB H P 3HP st.ta work Dat._ PULL TURBINEPW <br /> -- won Ovanscoon ❑ Wei'Dismetar Sca.li�¢ t ateritat a mP*� D 1H+SUB P�^ v, 'A., <br /> Oapth Piller Katerw a Depth <br /> x, <br /> TYPE Of SEPTIC WORK NEW INSTALLATION I i AEAAlRJA001TtON I i 0£5TRUC710N!t 1No tapes[system parmntad d pubMe earvar b an' <br /> ovarabtt wrthru"200 faet.l <br /> T Inatcl3baft --m rrvo Vtc6donco _. . Commorcio+_.. Other <br /> Numbcr of Rvd%o ureta Number of bndraoms <br /> J,STM ,�intir .tr' bt' ';y <br /> _ ry Chucctar W wq to a Q^pm of 3 foot. Water table depth =1 �h <br /> SEPTIC TANK ❑ TwolMfg Capoerty No Compardnsrum <br /> PICG TMATMENT FLT ❑ of Okposd <br /> i Olmonco to nasrca! Wolf Fowtdotion " Property Lb" <br /> � <br /> , 5 <br /> erti <br /> LEACHING LINE Cl No.0 Longth of i1nea Total lengthloiz♦ <br /> FIL'EA 9ED C Ohtanco to rst <br /> e -- -wed--- Foundation PropatY Line Y r - µ` �-;r, - <br /> dEEPAGE PITS I I Depen sun Number `1` m ,; w' 1 a�g X44 <br /> SUutS - ' Diawnce to nas ase wan Fowtdatron Praparty Lute +r <br /> DISPOSAL PONDS C3 � z' •;a�.a `r :�.z `> "�' r� <br /> I hweby Wnify that I hive prepared th4a appkarian and that he work Mri11 be Jona in aeeordance VAth San Joaquin county otdhtaneaa,atsa lavatr.1Ntd r1SrY,; ="'tO~ Pell <br /> r <br /> ndn artd ragtiietione of the San Joaquin County _ `4 "' )� - ,, ,. <br /> I cwtify that In the parlotmanco of the_ �_ a <br /> or vokh thW psi <br /> onw* =w oaraon h ouch manwas bwAtm aubMa o wctt kman a compensation laws of CalHorn Cont}racws hiring or tw�eonvwlk Oltai WILNv s 7r T 4� f <br />' ` { attKiteY - Y s-- ti t'fx 1 <br /> oert#!es thv fororwtq :e+th►ry thn in the perto wnw of the work for wn,clt this p.rmit+a waved I shsu employ rtrraaaf Mubiat#to uiorStwM+o CCn+gnq- i <br /> t tion Was M <br /> 'I+a ttppdiearte ittwe cos nor cr to on rmmrse suds // �* �y_' ��•' „� .+. �`�'_ <br />' ,S� REDUL SALES Dots <br /> FOR DEPARTMEN r USE ONLY <br /> /:FNcstfon Pet opted by r Data Ates <br /> 1 , 5 <br /> ft 3rotrt Intow0w by Onto Final Inspection by <br /> A 1Mchd Cahntant L +� <br /> tpplieact - ftettrrn all eaD-eo to San Toaquis County Public Health Services <br /> $ovi untaental Health Peralt/Services <br /> ' 44S V San Jonquis, P O Sax 9009 9titn, CA B5901 <br /> V ,r, <br /> ►EE .rJ'.Hn <br /> I uND AhICURT DIE AWUNT REMITTED I CASH pt'C21VED DY OATI Pdplmry No <br /> f 0 <br /> T +..✓.« a r w_c....yw. ... .- —, .� n1.' tiJ 1,..,....rn.—w F.i.MJ..,tu u4IiM—.yWxrecu,�eaC.4Y4Y/,rt��{(� 3 i y -t,l,1t Y.,.� <br />