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) <br /> �3 Bo3 <br /> 791 PERMIT I NO <br /> Nri <br /> eohone (>Oa S 6 Cgi DALE ISSUE <br /> PEPh1T EIFIRES 1 YEAR FRO^ 'vi=-I55—_hZ <br /> Yo-olete in Tripllcata) <br /> Application IS hereby rade to the San .10a Ryin Local Health District for a Denit t0 construct cr sew 1n5 tall the work herein " 1 <br /> Oescribei. This application is rade in <M'pl-fanC n[,Joaquin County rdinance N0. Sd9 for sew39e or No. 1882 for w¢P'pum0 <br /> and Lhe Ryles and Rpgryla 10h Of tN Sdn �i0d0 LL f /n'�.., C <br /> pJ/\ S Ddivislo dY _ /' ° <br /> hp Address }-- Phone f i <br /> Owner's Nage �+ ress - <br /> 1 cense t+o. L 1� Phone <br /> (OnnceLrdCLOr'S Na1 � + <br /> — � F <br /> TYPE OF YELL/Dtmtm BORA: NEW WELL ❑ WELL REPLACEMENT OEST0.UC1fON Lff O j <br /> PCWP INSTALLATION 1=J SYSTEM REPAIROTXER LI <br /> DISPOSAL FLD. PROP. LINE i, <br /> DISTANCE TO NEAREST: SEPTIC TANK $EWCa LINES —— _ „ <br /> Pol:'+DAT/ON 0.GRECUL"URC WELL OTHER WELL PITS/S1WPS __ <br /> iNtENUED L'SE Tv'r OF WELL PROBLEM AREA CONSTRUC?ION SPECII!CATI016 i <br /> IJ Industria' Lj Open Botlo* Manteca oil. OF well Fsta vattpn - <br /> U DPxitic/Drlvsto r-1 Gravel Pace ( ,trecv <br /> Ota. c` Well Casing <br /> 1 diID UOther (-1 Cal to Type of Casing <br /> Lj Irrigation _-ADDro•.• ❑Eastern 5pe91f Ica tions <br /> EDCataoafc Protection <br /> "`pth Depth of Grout Seal <br /> Type of Grout e - <br /> IJ Gen;',yiscal Yp <br /> Other Surfs,. Seal Installed by <br /> M.P. State 'Work Done <br /> Repair Work Done Type of Pump _ 0 <br /> well Des-ruction [y Well DUncter reeling Material (top 50') <br /> Depth Filler Material (Below 50') <br /> TYPE OF SEPTIC WCRK: NEW INSTALLATION Fl P.EPAIR/ADDITION A (tin septic tank or seepage DIL permitted if public sewer is <br /> ay <br /> allable within 200 feet.) <br /> Lmtallation rill serve: Re jdence x Conmerci st _ Other r <br /> Number of living units: _r Number of bedrooms —�_Lo! Size /"•- <br /> Water table depth <br /> CharaC-r of soil to a depth of 3 feet: Capacity IAKE No. Compartments <br /> SEPTIC TANG TYDe/Mf9 :a pact1�y Method of Disposal <br /> PKG. TRFATMEx; DLT, jJ Type/Mf9 r �opart Line N0 ' <br /> SEWAGE FA7MSYSTEM Oist.nce to nearest: Welt <br /> Fou"datloj+ Y <br /> O[S:RUClIOx _ <br /> Tn, 6 Length of lines total length/size - <br /> FEACNING LINE i-,J -_ foundation Property Line <br /> t <br /> FILTER BED ❑ Distance [o nearest Wee - <br /> Size NRmber _ <br /> SEEPAGE PITC U Dart, Foundation <br /> Property Line <br /> StIMPS -LI Distance to merrest: 'dell —_. ._._.-- <br /> DjSPO5vL PONDS %. <br /> ich this <br /> flat 1 <br /> laws, s aarulesae a regulations ofothenSan Joe ulnt the work Local1]I beIealte Districtell in ccordance with San Joaquin county <br /> We oh s55 s s alicelsehd genOtSPD10%tdny ......n14n t�hhe ,ma!nNndS t0 DKOm!VSUYa9t tothe <br /> workmant CdnD"Sationnce 0 �l awsrk frvf or(all California." <br /> Con t'aCtOr'S h5 ring or :uD-COIL raft Ing aigM Lure Certifies the f011nw1,9: '! certi, that in Ma ler}OI1Mme Of the work for which <br /> this Dervit IS issued. . 5411 /P'''�nY ^.P•SOnS S4DJta CO work ran'S !nm4tns.' on laws o Ca 11/C 5P1d." <br /> :he Dai( ecd:red I, Fact yIF$ Complete dr eing on reverse side, <br /> I-±4 <br /> �/7� D.t'0:Iioed _ <br /> FCa P• S USE ONV ex Ga 1 - <br /> Stk 666-6781 <br /> _ / <br /> AFolicetion Accepted ty L----__-" Lodi 369JA2 <br /> -_a tfo^.ai C, ants: ------- Man!eca 823.7103 <br /> =,t of Groot !es;vctlon t - Tracy 835-6385 <br /> -L1 'j � L <br /> r:%a: EU C•Ctlon DY -V---- (/-'f P.O. soy 2009• Stk.. CA 95161 <br /> ,• . zrit'Se"..-as i!' E. Nara)LOn Ave.. <br /> DATE DFDMIi !+D. <br />