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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. t1AZELTON AVE., STOCKTON, CA <br /> TRkphprm 12QSI ms-mi <br /> PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (CempllrR_in Tripdir ml <br /> Appleleen it P h eWAI M the SM JO"M LOW ilellit Die"I%W•P&M.0 to Contt'Wt anWet, are Wert heteet Awo6M. <br /> TThe Apir�ien•-ONn eMrPlWrp*40SM Jorlrin Cererq Oea+Wrq No 5q for ttergr W No. tt IoW wel/Ntr^rO Me IM Rr111I a110 RgrprN d Pn San <br /> Gxa fluhh WWI <br /> Job Addle" corY"�._.� La SBI L..C�i.._. <br /> . PIA <br /> OwswY(+• ma� Added Phm <br /> Nn..2Azf 07_��MhwZI-*Z`S I03 <br /> ( TYPE OF WELL/PUMP: NEW WILL 0 WELL AEPLAC6MlNT ❑ DESTRUCTION L] <br /> / PUMP UNSTALAMIN SYSTEM AFFAIR i' OTHER I 1 <br /> ' 01STANU TO NEAREST_SEPTIC TANK — _ SEWER LRI ____, DISPOSAL FLO__ PRDP. LM <br /> .._—.._._:..FDUNp1"TION=_m—_ AORrCIKTUIIE tlyfll OTHER W& I..._._ of SUMPS _. <br /> KMNOEO USE TYPE OF WELL PROBLEM MFA CONSTRUCTION SPECKPCATFONS -- -- — , <br /> {:hnhwelr Open Ba�aw i Mw�Yri- Dr.d rrorf E+n.wion Orl a WA c"% <br /> Cl bar+ancUP.rytn ❑Grow Pack Tr !—_ <br /> � ❑ouw Dem. ofPel a latera s.a -- TTw a awF <br /> bneelo. ..._AVI Depth '.3 Enrww Ser/aoe Sat 4w01Ya hF-.-... <br /> flepw.Won Dan. L Typo Of PanrD -- -- _ N P.--.—�—_— Stw WI Done <br /> WW DeertucTivn vvw OWnteeer _ _ Seeatrp Itweia nop wi <br /> DepthTo <br /> -- _. _ _ IAaleriil 16dow SCPt _'_0.+`YL�4 wEtdn 7q— <br /> rvpf DF SEPTIC wo" NEW WASTALLATION i PA Aper►IDN DESTRUCT , 1 eepc OI npf wt{Iee P aws <br /> kk fewer is wn{ <br /> !r•eteKetwn skk twnw RwMnca. JI CorerwcW_._ OOWr .,e. <br /> �- Nomeer all kwtp•nfa -1Number abg$VD-s <br /> 1 _ F <br /> CMracw M soil:o a otVlhhrf 3-Ng1�' -- - -A40M I.IIE iyErr , <br /> SEeTIC TAM 'I 1ype7Mfo _ _�..---',•Ql Ca0o0MP- SMO. Ce�IrInMRY <br /> PKG. 7RfATMENT ot I. _ <br /> Pster.caror�ereel. woo •`:{° h0da --.....— <br /> Fetreylew. NaOwtY Leto. —� <br /> LEACNING LWQ IYe. •Lwrlth of brew . , 1 • '�- <br /> 911 KDpow bnows D"aErrc�wnwrwf yyO�rl.,T.—._,.._...__.._.._ N. <br /> SEEPAGE►IrS I <br /> SUMPs .� Dim <br /> _ CteFanoe to nm~: woo R'_. ._ FwrMidea.? Pop""Lo. _ 1 <br /> DISPOSAL PONDS C` <br /> 'hobo ceniry that 1 IreWe PrqmmeE'atre aepilcmion ane and <br /> nA .:riR rM rsotk wR b Gene An.aonfnrw wiU San 1 <br /> te repiuowe d 0*5M Jpepyut Low FleeVlt D!etnct a+ana tarty ore'trtor,sws WI Who <br /> /fcww nsrnWr a iioemeer)Wont'.IiPw'lure oWphei the tokwmq: "1"o"y thee N the banpetrerwleft d Thd w rot Mich M Patnst.srrtl,i fern rtor <br /> e VIOV"oe aM �✓9 a'eti rhatrMr rW orta++.s .d tnr ww. swl`e the 00 Via,GMarw..' Cmuector's III a waaonarema ibrty. <br /> wruPu t>ti t I <br /> trwr#~,at CaMW,,, '. pYwW n wmrer/ 1 slava srnp»e Psrsprw etteecr b wakmn'a pnrpwtr <br /> •tre aP0`cerrt co rot "Oweerw. CorvP 4"ow^ <br /> 1 raEl USE ONLY <br /> APPlcaioa ALiiplee a <br /> ..�2 -^ 'em, <br /> Pt or Gran InePlcren be Date Pima bIIPloaew be <br /> AoOitiaWl C°nWnMrh: - <br /> So 411G taa 31s9Q1 r M.vw FP1Tr01 ❑ rawv W&M <br /> Apyrr,l Rede M ceObe fP: Eneke[elynNl Wath Peln11$Mtipee 1x101 F. 1LeVltrerr Aw., FI Ree 2. Sa., CA 16101 <br /> Aaeo�Nr PI1I urlow.llrrnm �eR lr wiT— <br /> /yJ eEMM7 NO <br /> --1.wfly IINy .e T4 �f <br />