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: 0 AI LICA_TION FOR PEf%MIT . •"} ttR ^� <br /> ��! SAN .IOAQU1N LOCAL HEALTH DISTRICT I AID �t <br /> t _ <br /> 0.1 16,01 E. HAZELCA n�1 <br /> TON AVE., STOCKTON, <br /> Telephone 42091 466-6781Af7i� <br /> PEAMIT'EXPIRES 1-YEAR FROM DATE tSSUED <br /> ,. (Complete in Triplicate) <br /> to construct 91 inI <br /> Application is hereby►rade to the San Joaquin eta.$49 fort for a8a or permit <br /> 7862 for won/ d tote Rules artd IFtsgufanuans of tf�e San Joaquin <br /> made in compliance with San Joaquin tl` <br /> Local Health DiFtrict. a <br /> Cit Lot Size • PM <br /> Sob Address <br /> kf �a '% F I Phone a <br /> k Address <br /> Owner's Name r <br /> -- if- <br /> License, o. one <br /> Contractor cess -r TRUC?'ON in <br /> ' LL.REPLACEMENT ❑ �.� � <br /> TYPE DF WELL/PUMP: - 4L ❑ '' OVER-13 <br /> ! PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ �itOP.LINE .� <br /> I i I SEINER LI E5 DISPOSAL <br /> • DISTANCE TO NEAREST. SEPTIC TANK —�— �----�� VIT !SUMPS <br /> FOUNDATION �• AGRICUL RE wEL OTHER WELL r <br /> UC°TIDWSPEGFfCa4 Nr`a T <br /> iNTEN� DE�fl USE TYPE OF.WELL PROBLEM AREA is.of Well Excavation { D . <br /> © industrial dope.Bottom fl Manteca I 'A Y� <br /> ❑ Tracy <br /> 0Domestic/Private © Gravel'Pacic Type of tasinDepth of Grout <br /> 171 Public n Other J Cl Dalt t _ <br /> + i 1 lnigation <br /> —Approx. <br /> �ox. Depth i 1 tam Surface Seas lrretaBad by _ <br /> f ' } H P_ �= ` State Work Done N S <br /> # <br /> Repair work Dona I7 Type of Pump r �°.! � � SIGN y <br /> WeN Destruction ❑ Well Diameter Seating_ aterial UUP 50. r. <br /> } Depth Fdter . tBefow 50'! <br /> om persttitted it pub7w s er is <br /> TYPE OF SEPTIC WORK: NEW INS�fALLATtb HEP IR'ADDETIOI�i 1.4 DES UCTf01+7 1 I avoilablIs within ZW feet.) L/ <br /> Installation will serve: Residence wj C r - <br /> 0 . f <br /> Number of living.units: <br /> Number of f. + <br /> Wjar <br /> �le <br /> Character of son to a depth of 3 last: ttltPt <br /> SEPTIC TANK ❑ Type/Mfg " Capacity s, <br /> 1 PKG.TREATMENT PLT,fl Foundation <br /> Property t_i <br /> Distance to nearesr. wen , <br /> TOW cangih/> 8' <br /> LEACHING UNE fl No. &length of!ares -.: <br /> tndation P#operfiIle <br /> r . _ <br /> FILTER BED 0 Dtstartrte to heart: Well y <br /> 4 � v <br /> SEEPAGE PITS 11. Depth Sum <br /> ' SUMS 0 Distance to r wonoundatiast Property Lire <br /> DISPOSAL PONDS D <br /> I hereby certify that I have prepared this a ' and that the work will tae done in acwrdance with San Joatluin cd[trdy ordinances.state laws,and <br /> rules and regulau_% of the San Joaquin Laca!'Health District. that In the P�of tho work for a. this perinit is Issued,I shall not <br /> Home owner or 1rce�ssed apefiYs signature Cettifi8s the following:' Corey to oub-controctin9 si9na�e <br /> I ernPlatr any arson In�sTach'h+anrres is to laeeotr�e subject to work#nan's opmpertsation taws of CafitI shell <br /> Carttracto a h to �.s canrpa I <br /> Cartifies the fonowing:'I certify dw in the pe rum of the wok for which this permit to issued.1 ahan employ pera4na <br /> L tion sews of California." I <br /> The applicant roust for all r inspect S.Complete drawing on reverse aide. k� , # y <br /> Data: <br /> ' f .Signed <br /> a FOR DfEPARTIiifEfilT USE!MIEN <br /> .Data � Z Arm r <br /> I Apptieation Accepted by . i ' .� <br /> Oats <br /> DatFatal Inspection fall <br /> Pit or Grout Inspectiorr-by. <br /> r# e <br /> # Additional Comment- 835-5= <br /> } 0 Stk' 466-6789 ''l.adi 369-3821 ,�0 Manteca 523.7104 ©Tracy <br /> tt2009 <br /> t50i E. lezaltort Avaa..P.O.Bou .Stk., CA 9.SW1 <br /> Applicant-Return all Capias to: £rtvironrtlettt81�4taafUt pametlStatrkes . <br /> I <br /> ffEtMZ!!j! AECEPJAO tsr OATS t7�ptRtTluo_t4•� - r <br /> _ yr <br />