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APPLICATION FOR PERMIT <br /> SWI JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E HAZELTON AVE., STOCKTON, CA <br /> Telephone 12031 466-6781 <br /> PERM;; EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> AWKrs hereby rnada to the Sar Josorwn I oval Health D-strw't for s fr#,,to construct Irnda�Wed;he R Ms worit hm n eu at*)M o/is This S Jo"' <br /> grMnnca wnh San foam•..County 011f.nom a No !An fur srwa!je or Nn 1P82 lot well' <br /> Lwol Heald Dntrw:t <br /> job AM•ess� J-cll!!`�l__._,.-.-- ------- C,ivQCQiso-_ Lot S,ze -- PM <br /> )wr•Cr's flame N /%�/s /V --- A"#-ts S LZ#011 _..._..—-— PION VV_/���/ <br /> Cvtlscl: liGllt�rltf.F�.C1tl __Aleress - 1MA a-'am dye--L.cenae No.���-1'In'*X4.1 -.f' zv <br /> 7YPE OF WELL,PUMP NEW WTtI WNL REPLACEMENT . I MSTRUCT" L1 <br /> t'UMP INSTALLATION X SYSTEM REPAIR 'I OTHER T1 <br /> DISTANCE TO OKAREST: SEPTIC TANK 70-`_._- SEWER LINES -- DISPOSAL ft 0 . MOP LIN! CJD <br /> FOUNDATION SO." AGRICULTURE WELL .�0�. OTHER WELL... _ MTS/BUMPS <br /> WrfrlDED USE TYPE Of WELL 11111"tIM AREA CONSTRUCTKW SPECIf)CATIONS <br /> I al _._. L' Ott"too"-,- <br /> [ MM+'NCa� Oi�,d vwil I>tt awtlofl"...../rZ.-��. Dy. of WM Cew+p <br /> ->Coamata tcrPrnNa yGry w Pack 1'', tr TV"a CM"L __-,OO<!K ...r___- spec Mtom �A <br /> Tv"IN(%#"I <br /> o,haK ntftar 's1 CMII•' 0+lt+�tM liF�rtMiT'.IN) ,,... �•s <br /> Inwytvar ��/Awn. paa•In QL`k Oa1Nn 5.�:rata Sw.., Ir.y os"WI by..«,.�a,1.,1[IR.,O <br /> Neparr Ivor Dong Typo of Pump SI+ 6 It P• _ J'- Stale WWII Data <br /> Woo Deafrlrcaon Well D.amefw sea"Material Itop 401 •-- --..-------..__.�_� --- <br /> Depth - <br /> 7ItPf OF S1 P11C W(mK NtW INST At IATION, t`Rt PAIR,AI)DI I ION 1 of SIFIOC IION 1^INP saptac aystwn "ultod It puhhc kovw Is <br /> nvarleble within 2W toot 1 <br /> Ms+aaa!rtrn wa snrne A~;Prrce _ C'M~c•O Othol <br /> Nrnbr M 1 rnn0 urrfs NornMr of berM:twW <br /> r►arax•er of sal to a depth of 3 teal W@W table depth <br /> SEPTIC. TANK I; Type Mrd __ ___......- Caoaetlr._ ._�-_.._ No, CampattmKnts <br /> PWG TREATWN'T PLT I 1 Maltuw of ompowal _ <br /> Drstarwo to rtaarree- Woo . 'OMI1 alien .. Pt(grrl) Line <br /> f1AtCNMGLIf* II Me SttllnWhstblah .. _ ��..,.. Totallefujthisua <br /> Fn►Ep t![O 1 1 Otwfanca to nurwt Wall _.._._Y., foIMMIIIMon Property t Ino <br /> SII PACA MS SRI "Wh <br /> Suka►S 11 Dw tear hj rurlrnrM Well _. FMrndattnn PtiN+aKy L late .__ w.. <br /> as•r^At PONDS <br /> 1 lawny caArf°r try)1 he.a pelp"ted thft app4 Afro- and that the wM► We lr'krrw wl a,tnrd rmK.a with San Jomjurn county nrdI Ancas, stats laws. and <br /> n/sw aed rapw{elrpny d that San Joapun Lapel"sallf r DAIritt <br /> 1s.rr►r ora t"to s¢anrsad sew"s Wonah.ra tv"O"I a Mia tnikK" A tarDty that err the j.erfnrrnanca of the work Ina which this parnwt K raauad, 1"mi <br /> was or aw r pallban M sLCh Inarrrar M"bacomm srA1a11 to wpkmrt's,;wWanw nn taws of CaMn calor-ContrarlM's hrnftp at subcontract"sinatuta <br /> canrtarl Mae#061 rt , 1 C@#Wv~in the paAnrwpnce M IM work It»*Mc.h the*permit e*rsauwl,1 shah employ roe lsnfna sut%wt to workman's com/ransa <br /> rgrr tensa of(i/ertua.. <br /> Tow aPPlram nrnraa Cas time fagtraad�Mrateana �AEto raUrlrlf)ort reyerN Nina <br /> R DIPARTMINT USE ONLY <br /> Ap1lcaarOrt Atcap/an/Ktw �/Y .._._...._ Onew _. '._' AIN '— <br /> P.r as fires)Inaartlrrn by / )-J''!q/'�_l,_..... --_.. nor e �� �.._,._ F.nat I Itartk.n ivy <br /> AAb+larw C'arwlryn Creep. <br /> Sr as 4791 . too 1w=1 �� 1237104 Testy lllrl - <br /> App ir4int flaium as Capin to Inywonnmwel kaaewh►annul'Serwicas IWI E Hamilton Aw. P O Bo. ?fY19. Stk.. CA OILMI <br /> tuff A&ANAT OLA At*f^^l 01111010TT10 MKIN/Q IT PATI NUMMI No <br />