Laserfiche WebLink
t <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT, <br /> 1601 E. HAZELTON AVE, STOCKTON& CAS <br /> Te*hone (209)4g6 M1 ' <br /> PERMIT EXPIRES I YEAR FROM-DATF ISSUED. <br /> AjO# awnppl c is fmreby maiitr to the San 3�nn Lanai Health pis bkg W a permit to oaf ardlor thin work Herein described. cation is <br /> ! trade in compliance with Sen Joaquin CounW O+d&rettae ft.50 for wwaga ar No.IBM for wall/pump and the Rules end flegulet#ans.of the San Joacpsn <br /> Local Health :, t7•� s r �a:;i► (re4 !�'7 ' . . Y.y R .. �'i <br /> 4 Job Askhess Ga r <br /> ENV <br /> �1 � Lot S. <br /> 50���� PM at ! <br /> f .owrra Ivan Address n -- X r3 / - ._. . . Phar <br /> Ct>esereCmr's Cleanse No. Ph.. <br /> TYPE OF WELUPUMP: NEW WELL IF WELL.REPLACEMENT 0 DES'TRUCnOM <br /> PUMP INSTALLATION SYSTEM REPAIR 0 OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK/_1R_2f!& SEWek LINES I C - DISPOSAL FLD.427J PROP. LINE S30-0.r <br /> f FOUNDATION _,Z9_L_AGRICULTURE wELL4xL OTKER wr-LL_X2A4_'_V PITAISUMPS — <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIIFICATIONS Q <br /> Q Industrial Il Open Bottom Q Manteca Dia: of Well Eicavation &at..of Well Casing <br /> i Damastie/FWva Gravel Pack 0 Tracy Type of CasingSpeclflcetip a <br /> ©Pubi'ic ' 0 Other 0 DdW Depth of t3irsutt Seal Type of <br /> ❑.Inigation ---.ApPrvx!Depth ©Eastem Surface Seal installed by <br /> F Repair Work Done 0 Type of Pump H:P: State Work [lyre r _ <br /> Weil Destructlon 0 Well Qlemeter'- Ses, Material(top w) <br /> �- Edi •• ' - Filler Material(Below lid') <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ©. REPAIR7ADniT10N,0 DESTRUCTION❑ (No septic system permitted if pub l sewer is <br /> available within ZD0 feet.) T <br /> installation wdtl serve: Residue Commercial Other - �k <br /> s Ntnnbet of units Nini4r of bedrooms <br /> l Gheracta sof ssxf lir a depth df 3 feet:i`� ' -# ... ..-...- yVauw table depth <br /> SEPTIC TANK D type/Mfg _ '�_. - -- Capacity No.Campernnents <br /> PKG.TREATMENT PLT.0 I Vethod of Disposal A <br /> Distance 10 nearest: Well " Foundation Property Line <br />} LEACH#NG LINE ❑ No.8 Lsrigtfi of linea t' '- «, Total length/ <br /> FILTER BED 0 Dlstursee to nearest: Wel) Foundation Pr"&ty Line +� <br /> SEEPAGE PITS � � 0 Depth Size_ �� - - Number L _ <br /> SUMPS ; 0 Distance to nearest: Wall Foundation Property line r <br /> DISPOSAL PONDS © <br /> 1 hereby certify that 1 have prepared this application and that the work wM be done in accordance with San Joaquin county ordinances.state laws,and <br /> rules and reWletions of the San Joaquin Lona)Health District. <br /> }tome owner or licensed agent's signature cert'cfiss the following:'9 cerdWthat In tlue performance of the work.for which this Pam-At Is Istued, I shelf not <br /> employ arty person in such manner as to bacons subject to workmen's cornydnafftian laws of California."Comractoes hiring or sub-contracting signature <br /> to the fdlowwing.'9 cerwy that in the pwrormance of the work for wtdcls this pwrnk is famed.I shag employ pwwm aulrbict to workman s somper— <br /> i tion laws of - <br /> IThe applrc� call for ap required" drawing an revarse side. <br /> g;gr,� Date: <br /> j Time: "L'1 .�>Yn E� - _ <br /> ,: FOR DEPARTAREM 118E ONLY <br /> ��✓ oe <br /> • : <�—� Area 110 <br /> ApplicationAccspoed by r ,lc <br /> r f.PGt�1�r Date <br /> Pit or Grout inspectku+ <br /> by - t)ats •y�I^ °^ <br /> AddWo nW Comments: <br /> I 0 Srk 408-$3$1 tl3 Dodi 'JW3Bt'1 '-0 fVlafrteca 1323-7104- C)Tracy II3"M � r <br /> Applicant-Return all coples to: EmAronmantel Realm Pa vnit/Services 1601 E_ Hamilton Ave., P.O. Box 20013, S*.,CA 85201 '•` <br /> #FIM AMOUW DUE `AMOMr REN1rEM CASH. RE 'DAT PERiHIrtflEp.`-'# <br /> +eH 13,%(AW,W8211 �, Y ..�„ fat ;1 r r`dti • - V 0 s- s <br />