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APPLICATION FOR PERMIT <br /> —' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AV- STOCKTON. CA <br /> Telephone 12091 456'6761 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1 <br /> (Complete in T,,[Awalet <br /> APIAKiIrm is 1w-ebv m]a1•o the San Joathnn Local Health Dntncl for 3 perms to construct and•a,a>ae in,work heroin deunbad.This a.Plicallon n <br /> "io m corrrpkanae with Sen Joxano County Orrfelan,o No S19 to,sewala or No )a4 Ito wvenulmP ono❑w Fulcs end heematiera of Ore San Joagurr' <br /> Health O/tlwtL A ) <br /> Ion Addtasa Q(W �_.l Yl� -_._ Coy �rS)SMd_Y^ Lot Sun_1�tL.6LL=SL.G PM <br /> IV <br /> owner's Name( 'Q♦'}�_ --AkA• <br /> VU lVJ <br /> p�r�f, �1 <br /> PnUn <br /> IOnIraLlgL.yL!'tOa (asl` Llwsaa=.-`3'Addle»L•`:iL1�A1.�7_.EJ�!_:.__Lne�•^NoRUCTIr <br /> TYPE OF WELL/PUMP: NkW WELL Cl WELL HCI r AGEMENT I GESIRUCTION it i <br /> PUMP INSTALLATION (I SYSTEM REPAIR I I OTHER O <br /> DISTANCE TO NEAREST: SEPTIC TANK _ —_... SEWER LINES .. ---- __ DISPOSAL ILO.--- PROP.LINE _ 1 <br /> FOUNUAFIDN __ _ __ Abnwuci URE WELL ____ .. OTIIER WELL_____-. PtTS/SUMPS <br /> INTENDED USE TYPE tT 'NEH. PROBI FM AREA CJNSI RUCTION SPECIFICATIONS <br /> IrMuabbl - _ I I Opnn Hmmn, M.hw. D, YI Well E\aavab.r _ __ ___ Du.o1 Well Casing <br /> _ _ ____ _ S cdd.vons <br /> Uollaflwll'nval! 1 l;r:va pas\ 1 ,v.' TYp'oI C,.,ng fa 'DTL7`� <br /> puN t 1 Dllwr D:1. Deym TYpe o'Grout <br /> k <br /> hrrylawn AI9w0> Uemh (,Horn Sr 4.. LYJI I sr IWJ bV <br /> ❑vMn Wml Doo! 1 1 Tyw of Pump _ - __ lip _ _ - Slat!Wail,Dam <br /> a� Well Deslmcum L: Wall Damele __.. SeoenR Malc wl <br /> Gafnn _ _ br Mata•al IRr.'o.. 50'1 __ - -- --- h � <br /> I YI'E OF SF.PIIC WORK. Nr VJ INSIAI LAIIONIII PAI AODIIIONDI.0111ICTIOR IM1 s t I >Y Iron pmmnatl rl mIbIK ww.-ir. <br /> / avJ labor w•Ihrn 2W fine 1 <br /> rnsHllalan wrE serve' R.>W<rr. Y CrNmMrc al _ 111,0 _. I n Y <br /> NomDw of lung unts- 1_ Number PI 111 wits .�_ /�/'� y <br /> Cha:acla of sad 10 a depth of•1 bol: �QL -�>I�C>��,- -— -- ----- Water labb daplh_ 1.00 + <br /> SEPTIC TANK it TIMID - 1�.. "i� ti-}h •�3> Canu." ____ ___ No.ComW nmonts <br /> PKG.TREATMENT PLT.I I (f Melnod of Drwo•al _ "�I E <br /> (nen Lina 9 <br /> a. DE>a, .to Pearaat Web _ F.moats _ __ Y <br /> LEACl/ING LINE --_I I No�6 Lmy11,of Irlaa __ _ ._. T waI I ngln'siT-._ <br /> FILTER RED I I Dntaoce Io neatest WHI F fah. _ _ P"'.."Lote <br /> _- <br /> Va ___.___. _ _!� <br /> SPITS i•\Depth w/ <br /> SEEPAGE <br /> SUMPS <br /> t OnMncn to rweresl' Wdl 1L0 f ,noel I � r 1 PrnpnnY <br /> DISPOSAL PONDS I <br /> — I horeb,uM.11,that,I nave 4 elata0 the.al,o..lwn ann float ttw work w U t" Anna n a.c I m••with San J.agul.Cnun1Y oN naneas, late Wws,and <br /> s <br /> rules na oi,ulLwna of Ink San JYgmn Local Ilmlth 03tnc1. j, <br /> Noe.weal a ed aW.".w.'ure eertdu»thn IoNeamM,Wni,"I 1Y Incl m thn Iwdc.once of the work for ich this Wont.,..ad.1 shall not <br /> Nome IKenfY - <br /> XmpbY ahVtUCh manna,.,IY 1 o•Ya lnji,%t 1.V,olknar�f t4n,V••neJlr.n Nw>YI�ak101Ma. Cnnlaclo!f h11r110 O(eYb CDrr1I]CIIrtR SBn]tllra <br /> emotes IM loyow,%:"I candy that in 1ho nnnc•mance YI lha wonk for ...... 1 stall empluY Persona f.braJ 1.workman'•con\nae <br /> tem Wws of CWAanla- <br /> The epMKsn.�rusl ua fo W ad in:alecuons.Cnr plea d•awrng on revms.vle. <br /> S'• X� A- '',Q Tole. —__._ �.•—�_f ---—__ Data: (uu••,�� \p 1 <br /> 11/Y OR D ARTMENT USE ONLY r <br /> /� �.'/�. Data l 6 Arita 1 L7 <br /> nPlih.uon Act PY <br /> Inslllon <br /> 61), <br /> 1 acDMs L (�� Final aoDY Dats�1]:� dY,( <br /> A•11pt GmrnE Inaptinr: F.i �f'-r-'� <br /> LAAdddilanal Coplmems' — <br /> D Slk 4666781 L7 Lodi 369-0621 ❑Monbcs 8231:/ ❑Tow 035'6386 CA Will - <br /> ApWicsnt-RelYrn an afsiss Inn En""'hanMl Haaah Permit/Sonic»Idol E. H...lion Ave.,P.O.Bos 2009,Slit, <br /> TEE AMOUNT DUE AMUUNT R[MIITfD iqy� PCCfIVE08Y GATE PER:aITNO. <br /> Xf0 -- i ) I� <br /> "» mu»un., t_I . (+ ,1. 9— �Q z�k%rL !U•�IY rJS <br /> -- <br /> — I <br />