|
s
<br /> APPI ICAEION FCIL PERMIT -
<br /> SAN JOA0l71N LOCAL HEALTH DISTPiCT
<br /> f:. HAZE',-I DN AVE., STOCRTON, C
<br /> Teli:nhnoe 12091 466 6781
<br /> pcpNliT i'.!'DIRES 1 YEAR FROM DATE I`"'1V4D
<br /> - IC Nplete In Tnpl rdivl
<br /> 0.rsArn+m K Me Mn•naJr m V.Liao!ceT`vv ln.a Haet n C sI Inr a tnr '1 , ern •vcl urn r tAl the vmtk Im,elr desuihmj This*Relll oinn'n
<br /> San.P»nu:�G:unN prnma•v a 11n._iJ lo'sewage o N 1Pba Ln wxll ,i p and the Ilules v-'d nepubtona of wa Sell Jovnuin
<br /> Llx, ri'Alih D/-"Yt ) �1 Ae y
<br /> ab Adbess L c^_L.iir`' ^?'*C--— '—
<br /> City f+14.r.�.t: c;,e J--.IL=r3� PM
<br /> J
<br /> �. FSUb?£
<br /> _ tis -- -
<br /> Owneis Nome LE_._ ."-i
<br /> Phalle._ -_
<br /> Crnhacta_
<br /> WELL i I WELL REPLAG MENT ❑ DESTRUCTION .1 l
<br /> TYRE OF WEUJ WMD. NF.CI OTHER ❑ r
<br /> -" "- --- PUMP INSTALLATION Li SVSTtM REPAIR L7 I
<br /> DISTANCE 10 NEAREST: SEPTIC TAN% --
<br /> cEW'.F LINES --- DISPOSAL FLU-----1'POP.LOW
<br /> -----'- � FOUNDATIrN ._-=AbRICt`LTVNEWE LL__�
<br /> CTNEF WELL____PIT.S/SVMPS _
<br /> INTENDED VSE - TYPE OF LJIL ^POB:EAI AREA EONSTPUCTI�M1 SPECIFIC ATICNS --_
<br /> an O Manteca a. .1
<br /> of Well EPanm;on_._ -- Dia.of Wal Ca"N; --
<br /> CI Indnslb0l Cl O eobam Specifications
<br /> f aril Pmk Ll Tracy - Type ul Cesitg--------
<br /> ❑D.m Iwj Prr.ste L� ur f}Delta Dap[h M firgrt Seal —_.---- Type al Grout
<br /> I`po ___.----- -
<br /> p ❑other
<br /> Am, pepth I I EaslWn Snna.•e SewIns.+IkU in_
<br /> I 1 h,igalt 1 .—. _—51xa'e�o,4 Dona—__.------
<br /> /,1 __ _
<br /> Repast Y/pE[Mee Ll TYIN:rl P... _."_— _.— $uvinNl.•datenal(lop SIT; ____._. — -- ' _
<br /> Well DIPAIM60., — fPkl M.4rsl:801ow NTI
<br /> DeA1M1
<br /> avaaahw within 209 fact-I
<br /> TYPE OfIYPE Of SITXpN j;,STAlUT10`:I1 I'I:PAu11AUUliION I. UFSIRUf,.TIUNI INo sr,pbc system(»rmnterl it V,dev.+ewsr,s
<br /> Irwla4.unvntl terve: ResideMe__
<br /> Carlln»rcul
<br /> •'
<br /> umber of Lvi,g An:� NW atter M bedroom;— ._ -- .——Water table depth__
<br /> 31kDY r�=,qui _
<br /> Cha•>c[er n'sotl m a depin rl 3'sen — __._.
<br /> ❑ Type/MR_—.__ ._ .-- Co Dmsn:a II
<br /> SEPTIC TANY• IMethod
<br /> of of Disposal _. — -
<br /> PKG.TREATMENT PLT.❑ Founnallan__ ProPens'Linn
<br /> Distaw Io"Pmt: Well—_.—. B
<br /> _ -� =- ►
<br /> -/ Ielglh/daa
<br /> LEACHING LINE V No.8 Length o11Mlr ..w�:--. - fW ----
<br /> 444 I»ry
<br /> FILTER e1D L7 Distance tp neamst: Pro sme_ ---
<br /> cFEPAGE PITS 11 Dxolh
<br /> SUMPS L 1 D'eunce to rluon[: .YMI Four,dTkn.___—
<br /> ProPiiny Lil
<br /> JISPOSAI.PONDS _�1
<br /> I herabJ"I'll IM,1 M1nf""pared,his awlkmion and tN'.L a work Wit be,done in accordant,with San Joaauin mun:y rplin•ncm,seta laws,and
<br /> nasa and npublkn of tha San Joaau41 Lucal Hcelth DA!'Cl ,.
<br /> H(aM pstnrI,a Wm+•u a5prd'a signawre eenif,aa the to 1, ..ngrn»n t cornr»nsalion 4wat,that in theaol lLal loar,iahe Contreclnfa ai/irg ar fut4eonb clirg BnBto a i
<br /> d any t»,ao„1,"o nls..'ae,a bKYm wbjarl�.wW sholl e.m raatl.wb et to w kow n'a eolry,anAS r,
<br /> rnrtirlss tM Ieam inp:"I:vnilY Inas in,he padornanrtn• M v,;wk Icr the q.tmit is iaauW, ploy W b {
<br /> tion Hwa of C. i!d nw, " ,
<br /> TI»apdrant Dtuat sllv atl rpuYed i spacl 4crylnte dravnnp On rcvorw�n:w. ! ,
<br /> Sb:»d%, ��T.L—�le Title Data: v ..
<br /> oR ARTME USE ONLY
<br /> /C -- Datn raB—f 'T
<br /> Applkvflon Acc.Wm by:8%8ka G • !
<br /> . pets FL,el lr.apeetion b- &'',� Date
<br /> Pil or Grrw In..poctbn OY '"
<br /> Additiar»!Calene•ns: ' —_..I Memau eY7 7104 TiveV 83CrSJ:15 —
<br /> ❑S& 4E ifini ❑Lodi 3W».352t Ayre, P.O. em 201% Stk..CA 95201
<br /> Act".,�P.Ncra a0 WPM"to:Env rorans•�ml i:,elin Pernit/Str"ws 163,E.Neun•.r.
<br /> FEF AMOUNT OVF :•MOUNT REMITTED DA,yN P_11%n0 P ` r DATE PERMIT NU.
<br /> INFO - I q J
<br /> IN a
<br />
|