Laserfiche WebLink
.6OAQUI XLALTR DISTRICT <br /> If't" SAN IHazelt n Ave Calif. <br /> POI. m"'Ir E 6• 1602 E. ,ephoa, Ave., 5[ockton, <br /> ' Telephone: (209) 4t6-6781 <br /> APPLICATION FOR HELL CW15IRllCTION OR PCRO' PERNIT Perw1L NO. 77-f1d1 <br /> I Date Issued <br /> THIS PEfUQ? ERp1RG5 1 YEAA FRON DATE.ESSL'ED ' <br /> AV4Y (Camp late In Triplicate) <br /> Application to Aereby made co the San Joaquin Local He 1h niatrict for a parxic [o coMcruct <br /> Courcr y OrdiaanceffiNaw 1862ea dlcha Rulesd andtAagulationatofnthe SanaJoaquwiLocal. Healthg0'tx*ct' <br /> .,� Ie •Y-m + CENSUS TRACT <br /> JOB ADOUSS/LOCATIDW 7Y •t v . i- /L_.. ,eat <br /> `v...�- phare <br /> 0emer's Name I City 40 <br /> 0 <br /> p <br /> Address Z47 License phone <br /> Contractor's Noma <br /> __..�._ J DESTRUCTION �--r <br /> TYPR Op WORK (Check): NEW YELL DEEPEN /� RECONDITION L' <br /> PUMP INSTAL TION I 1 PUMP REBAIR LL RMRRPLACHl�WT 1,• <br /> Ocher / / <br /> ' SEWER LINES PIT PRIVY <br /> DIStANCS TO ;7SAREST: SEPTIC TANK �_ �_ CESS O0LIMPAGE PIT— OTHEa <br /> SEWAGEIDIS OSy�. FIELD PUN 1£ DOMES IC L <br /> PROPERTY! Ll PR VATS DOlIiSTIC STRUCTION SPECIFICATIONS <br /> INT�EN_DW USE 'TYPE OP WELL '� <br /> � Cable Tool DSa. of Well Excavation a <br /> Industrial a.Drilled Diof Well Casing <br /> ` Domaatic/private = Driven Gauge of Caaing <br /> !� Domestic/public Depth of Smut Sea, <br /> Gravel tack <br /> lrLhOdle a Rotary Type of Grout <br /> _Cachedle PregeClan ,�Other Other Information <br /> Disposal ! Setface Se 1 In 411ad aY- <br /> —�Ceophyaiesl <br /> ` NIPiWSTACIdTION: Coa[lutor 10 f< ,p• <br /> Type lof rum <br /> i -7• State Work Dina <br /> !UNP REPLACEMR412 L <br /> t PUMP REPAIR• __L� State Work Dome <br /> Appro#iaata Depth C <br /> DESTRUCTS Well DiasattT <br /> Describe Material and "needs'LaLl <br /> L hereby arrea'eo comply vlth all lav ardor rcguiacng Veli cooatruecfoe.�With <br /> icaPIFIRERtDAYB <br /> and the Stare of California parMining uin Local Naaith District s <br /> +Seer completion of my vork on a nev veL1, then before PuetI San JoaquinIft <br /> WELL DRILLL'RS REPORT o'f the we 11 and notify then and <br /> el putting the veli FOR <br /> u G The abmea <br /> information Se crus so ch e t o e kaa+ledga end belie[. -I WILL CALL FOR A GROUP INSPECTION <br /> Px[Ot iO�RReDS .G fU A F II' SOIL.- • • TITLE - <br /> SICVPD ORAV .LpT PLANOY� RSE-SIDE . . y <br /> FOR DEPARTlDmT use ONLY . <br /> PRASE 1 �Q _� DATE ^W0a 77 <br /> . %yPL1£AT10N ACCEPTRD RY �r INSPECT <br /> 00 <br /> ADDITIONAL COMMTS: PRA III F INSDATP_ <br /> PRASE II G OWI' INSPECTION IRSPLY'IION BY y_ ��ry <br /> LNSPECTION BY E __ _ IlI7 (A <br />