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I .� <br /> L:CAT; C or_,q <br /> '�� .,�.. ��-_,.;�. LOQ:A� �: _-; �•�-:,�7 3��� <br /> - PERMIT NO. C=� <br /> 1561 E. HAZEL TO', 4'JE., ST:1C•.Tu%. CA <br /> Telephone (209) 4f5-5791 DATE ISSUED <br /> PFPMIT E011RES 1 YEAR FROM DATE ISSUED -T <br /> (Complete in Triplicate) <br /> Application is hereby made to the San Joaquin Local Health Cistrict for a permit to construct andinstall the work nereln <br /> sew <br /> described. This aDDlicatipn is made in compliance with San Joaquin County Ordinance N0, 549 for sewage or No. 1952 10^well/pump <br /> and the Rules acd Regulations of the San .Joaquin Local Health District. <br /> Job Address/l Sy 9_1G y/wy 1�C Subdivision 'lame <br /> Address _Z ry lrf. PhoneT�9"iy�c—.. <br /> Cwner's Name fTi ✓ - �i,KA r `Q_,�C/S <br /> License r:o. F'.9� P�;�: Phone 59 <br /> Contractor's Name_ — �+.�� <br /> TYPE OF 'WELL/PUMP WORK,: NEW WELL �+IEIL REPLACEMENT n DESTRUCTION i% <br /> PUMP INSTALLATION ❑ SYSTEM REPAiP• L l OTHER IJ PROP. LINE 1 <br /> DISPOSAL FLO. f„ <br /> DISTANCE TO NEAREST: SEPTIC TANY,�f� ar F T SEWER. LINES _ PITS/SUMPS __ V <br /> FOUNDATYPN AGRICULTURE WELL _ OT.u ER 'WELL — r <br /> INTENDED USE TY.^E OF HELL PROBLEM AREA Ct)!L R CTI.N SPFCIFICATiO'b J <br /> Dia, of Well Excavation <br /> I] industrial U 0p:n Bottom �Manteca Dia of Well Lasing - <br /> U Domestic/Private '�IGravel Pack LJ Tracy <br /> Publi,_ U Other Delta Type Of Casing <br /> LJ Irrigation _ —r EasternApprox. <br /> Specifications <br /> ED Cathodic Protection <br /> Depth Depth of Grout Seal <br /> Geophysical Type of Grout -- <br /> [:_J Other Surface Seal installed by <br /> Type of Pump H.P. <br /> State Work Done <br /> 1 Repair Work Done yp - _ <br /> ' Well Destruction U Sealing Well Diameter _ 9 Material (top 50') <br /> Depth Filler Material (Below SO') —� <br /> s)�• permitted��, public sewer is <br /> TYPE OF SOTIC WORK: NEW INSTALLATION RE i t (+to septic tank or seepage piavailablewithin 200 feet.) <br /> Installation will serve: Residence — Commercial Other Loyd <br /> Number of living units: Number of bed <br /> re/omz Water table depth _,3g <br /> Character of ail to a depth of 3 feet: Capacity _�1?11 No. Compartments _ <br /> SEPTIC TANK C Type/Mfg Capacity Method of Disposal _ <br /> _— <br /> PKG. TREA7M':Ni PL7, Type/Mfg - z Property Line 8p <br /> SEWAGE SYSTEM Distance to nearest: Well �o�'T Foundation �D <br /> ' r <br /> DESTRUCTION <br /> Total len;th/size <br /> LEACHiNG LiNE _ No. R Lengtn of 1 i�ne�/p Well >'1 - -�-d Property L• �� <br /> CC Foundation - <br /> FILTER BEC Distance to nearest: <br /> Size Number _��- <br /> SEEPAGE PITS �J Depth _-_ - ---- propert- Line - <br /> a. <br /> SUMPS <br /> L Distance to nearest: Well __Foundation <br /> DISPOSAL PONDS r <br /> be <br /> ordinanc sreby erstatPtlaws, anderuleDaand regslatiionsaofotne anhat the Joaquinw�ocalrk ill <br /> HealthdDiistrict accordance with San Joaquin county <br /> Home owner ar licensence <br /> d a,en•.'s signatnn�. certifies 5uchthe 'mannernaz to become sub,lectthatntohworkman�compensationwlawthe Califorork. for which nia." <br /> �hdil nOt "'";toy Y that in fhe Performance Of the .H:rY ROf which <br /> permit is issued, 1 -y <br /> Contractor's h- or :JbF3ont `ley'..ErtOnSusubjectlto workman'slceorpensationrtifs of Caiif�rnia." <br /> this perni t. is / <br /> The aDP',lcant must call for all required inspections. Complete drawinn on reverse side. - Date: -- <br /> Title: <br /> Signed. �.s� 'fc�l � <br /> rr,o DEPART": Or. /___ ❑ $tk 455-6721 / !•i�I'C <br /> �I ���LS�2i! ;area Y/ is <br /> A;,�: icacion Accented r-y � �J- -- C:'i _odi 302-3521 <br /> Additional Com^enatl /i_-- -.---- �,p X Manteca 823-7104 <br /> Pit fir :rw_ Inspectinn by ---------- -. L_i Tracy 835-6395 <br /> - 3oY iOOo, atv., CA 9520; <br /> Fina; ln'pection Sy � "- 601 E. Hazelton Ave., P.Q. <br /> e'n:at Her.r.n %ermit/Se'v:CPS i <br /> Return all 'es to: Environ'. _ <br /> Appi,cant - _ --- ------'- pEpvIT 140. <br /> piOA,ECEIVED BY� <br /> f NT DUE <br /> BASE I 'CJ <br /> r <br />