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APPLICATION FOR PERMIT <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4::o <br /> Fr <br /> 4�4 3 p - <br /> i N <br /> I d 'e; HAZELTON AVE., STOCKTON, CA <br /> 7 r "; Fx 3 � Telephot a {209) 4&6-fi781 <br /> 5 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IComp{ete In Triplicate) <br /> Fl <br /> Applicatlort:jst Mtepyi,tetade;ci;the 8eti Joaqulrt.Local f{eelth.Dtstriet for a permit to construct andlor install the work herei cribe :This apph tion is <br /> 'nada Iii ea�rtpliattceiitrtth San Joaquin 1Cotutty QtdMarfce Na 649 for))swage or No. IOU for welltpump and the Rules and Regulations of the San Joaquin <br /> s t,oca4 4lsaltt�District': "' <br /> Lot Sixe PM <br /> Cita <br /> . 1^Joh�rtiaa y <br /> Phone + 4 <br /> F � <br /> F. �b <br /> License No. it Phorte_i <br /> 'a <br /> ftP + vatic B �= <br /> r! r > TYPE QF LLIPUMP I ?�fitElTl(,WELL ;F -,WELL,REPLACEMENT ❑ �.,. DESTRUCTION ❑ <br /> MP INSTALI ATION C3--. SYSTEM REPAIR❑ t OTHER ❑ <br /> rISTANE 7Q NEApES :'SEPTTC fAIVK :SEWER LINES i DISPOSAL OLD.- PROP. LINE ' <br /> : {, ,... PITS/SUMPS <br /> P:fOLINDATION w,�. .AGRICULTURE.WELL QTFfER WELL.,.—._ �- f <br /> ` Y PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Y r 'iNTENOED USE TYPE OF WELL <br /> L � �Y�Indusertal T Cl Open`,Bottom < Q Manteca - Dla of Wel Excavation. I*.of Welt Casing <br /> --Q 06rrwsoc/P&ate� 14 Gm%df ack�" fix :Trocar peojC+ssei� tFka .t.` i 5pecificdttons <br /> -' t'l.Pubtit ' f E other . z _ C1 Deka t5spth of Carouf SsN =`�' Type of Grout'` <br /> ApprA><, Depth,,,,1 I Eastern T Surfa"Seat}tnsteNed bv.�� ` ti^1�• <br /> Work Date1 ryps t]f FPurtt WorkDoh9 <br /> k. <br /> r W811 Destrucnan� © Wel Dtametef #' Y S61111".(rAltertil Ita�p J9Ft s} 'Y• �"} Y — <br /> Depth <br /> �� g x• FiW AA.Mriat Below <br /> TYPE OF SEPTIC WORK NEW INSTAL[JITIOAf€ ; REPAIR/AD{?I N I f OF I I INo septic system permitted if public sewer is <br /> available within 200 feet.) <br /> �" . 9ttatalfation wdljserve. Resedert 'Cannwdal <br /> Number of Living units ,� .. .FVu �::bedrgor:?s ,-,..� <br /> SOwr cter of sol t3 0 depth of 3 fast Water table depth - <br /> Ypllfg <br /> PKG. TREATMENT PLT,#�, { ��v„ _Method of Disposal <br /> s r € ' Distartee to f; Wel foundattort _ - Property I. w.: - <br /> ` <br /> -47 <br /> LEAC1fING,LINE _[ if.Lertgth.gf Grtes Total length/vaa <br /> r �r x` IL#ER 8E0 r r ,Distaralcs to ftearest WaN _ Fourtdatton PrTenv Line . <br /> r -3"7T1'{`' e+;, r xis yrs' u »,! r ti w cpw"eek7 y ky�'_,i-•+- . . KW o-.r r Fly _ a n <br /> ILA <br /> � <br /> fSPb A!$DNDS' <br /> 4 tno <br /> ' �alts))ana�x` �b]a t tQ�wackmset`a �`� <br /> 1�w•' - '.��� l ?- ^i5 ..F 5�' .l4tyS a1 a y � , 1:r��s <br /> .F 3 ..�FY <br /> r ,06" 1- <br /> ii z <br /> Sik' 48540*' <br /> ' ►pvNruttRaturtt�"ail int nA. <br /> FFE <br /> vs, <br /> 444 <br /> INFO A1ttpUNT DU! D ,r .�n RECEIVED BY DATE PERMIT'N0. <br /> #-#N 13.74 tlteV A e via) <br /> go <br />