|
—��'M:(�•^ro iYrr rwraro¢sir.-�0�31r�b'JltRla[p'3S�"itv„
<br /> .,b
<br /> APPLICATION FOR PERMIT 77
<br /> SAN JOAQUIN LOCA,_ HEALTH DISTRICT
<br /> L ]Fl)I E. HAZELTON A Fi STOCK TON. CA
<br /> I rlepbont 1109) 466 fi/H1
<br /> PITIMII EXPIRES l YEAR FROM DATE ISSUED
<br /> ...__.,�,_,�r .ri.. ICnlr"rh,.'„I„r Il,phr,,ltr•)w. •r! .... w i nm inn n +
<br /> •i PlJu.dp, :h. .,Y, uh.1. :M1r. Ln9'i'•(. ally rrn n1ln rP,
<br /> i.i.• rnb.. in. r l•• n!. r.... Iu, tic.l ou, nlvvl fine Sets j.re
<br /> . V�dni .rlu `.,'r r:. ..•L� 1•. :hu , Iv'p:. ul llu.lhArs
<br /> ml Ilelnrlal s nl tIM S Jlr[rpr.
<br /> . - Jr,b nrlrhr•s.�"'
<br /> r
<br /> ����`(✓tvl.fi['JI-L nv J/v�+ 4ieUerI-",u- .. _ rM
<br /> L
<br /> Uwr s Nelle an�T�y QA/eS11IX ,:,; 3�?S'S rlGssoF✓ �/b�.Sf 7r2_z.�
<br /> rnooe
<br /> . tJ•, An 23 Pies, y_6_ 7:942F
<br /> L TYPE OF wl-L,I UmP Ntl1' FlL Wtll HIPIACI%ITNI 111S1RbCT1UN
<br /> PUMP INSTALLATION f 5,51EM RIPAIII :✓ OTHER I!
<br /> DISTANCE TO NEAREST: SEPTIC TANK _. SEWER IMES DISN)SAL ft _ .. PROP lNE
<br /> - �- FOUNDATION AGIIICOLTUit Wf,l UI IIIA WILT PITSI UMP5 _
<br /> INTETJ ,EU USE TYPE Orn I PROM Al AHFA CONS,HiJ('110N :1'f CIF,CAI)VNS -
<br /> L Til al On,Rpu n AT,t, a Ura 111 R,vl E Out. f Wel Gses,
<br /> f�mra¢JPriadie .Urave!Pack Trac, Tv,u-or Gout Sliec feeble.
<br /> Puhlc I.Giber Drib Ov"I"GI(haat Seal - Type et Give,
<br /> upe:wn At Iva..O,—,IIO,-,Ih L a,enE Iy� a ml Ill” fl I y- _ _ _ _ _ _1
<br /> y Re
<br /> ,.r Wmk Done wT,sx of Pump �� Y P. Sim,Wnrk Me ��Q—J�J/ SUS
<br /> Well DesPm
<br /> ucbon Well D'i elr ._ _ . SeM.n, a
<br /> MJr! -HI F 501 _ �(�k.�Q
<br /> OeUth Filler Ma1cm.1(R.I.501 - o �� LP
<br /> Iri•E Of SEPI IC WOR Y. NEW IN STA I A r ION i t RL PAIR'IUD-IION, I DFS I'THC I ION: I (No sepnc z,nl Wrmmnl d pulik sewer is
<br /> L -- wrt nn MIT feeI.)
<br /> Ins.aliabi8 r
<br /> nn wive: pestilenceae'J.bIlarct_.. Commercial__ Other _
<br /> Number of I.'uq uNts: ._-. Number of bedrooms
<br /> Clu,acter of sod to a depth or 7 feet ._—_._.._.- _.... -_ Water table depth
<br /> iELPTIC TANK 1 I T,p+/Mfp Capacity_._ _.__._._. No.Comprnments
<br /> PKG.TREATMENT PLT.I.1 Method of Disposal
<br /> Distance to nearest: Well .. Foundatian. _ - Ropenv Line
<br /> LEACHING ONE I:1 No.9 Length of Frits .__,__._ _—_.__._._—___. Total Icm9ih/sire_.—__
<br /> RL TER DED I I Distance[n nWrest. Well Foundation ...__._.. Pnmany Line
<br /> --- SEEPAGE PITS I1 Depth _..__.__5ue____.._ - _._— _ Nemt`er
<br /> SUMPS I i nnience m neli Well __ __ ioundabun .__.._ Prorenv Line
<br /> V DISPOSAL PONDS I) _ I
<br /> I.mrebY certify Thal I have Prepared this apieicabon and that the work will be done in aawdiuce with San Joaquin cuenty,prdxunces.state.awe,drat
<br /> rotes and rapouT• r�TTnvSon Joagmn:.ora!Heaah Clinic..
<br /> Horea owner acensed.9l. I's sipnamre canlllas tulbwin,"I certify that in Ina par!armance of the work fo which this permit is issued,I shall but
<br /> erg:pMy airy son in s�xt. nnor as to re !cel to woM1rnen's compun.,lam lz w-of C.1dre ea."Cuniract.,s Ill"or sub<ona
<br /> nnu0 sgreater.
<br /> I:enibes t IOMlwnp:"l c• "'y!Iw n �d massa of the work Inc whicl�tl+is perm,t rs issued,I Jall ampinY pa•sans urb,nct In wrakman i eomponsa-
<br /> :ion b of Celr iniac' /
<br /> 'rhea 'ice i r� an f e,l r u i / �• 'Mn.a nrawinD un sidir�f� p
<br /> Sin: xj�'/_ Gala: -3:U /
<br /> ` OR DEPART NT USE ONLY
<br /> �J G
<br /> .pplicetisn Accepted by _��--/-�---_� —c��'Y — Dau sv�' Aren.
<br /> Pit m Gout Inspection by Data—_ _ Final Inspection byDain
<br /> ` 4anional Comments:
<br /> ! l SO 4kiF781 LI Lodi 3697621 n Menurs 623.71N ❑Tire, 835 63e5
<br /> Applicant-Return an copies to: Erv)ronmental Haal:h Parmlt'Servicbs IWl E.Harahan Ava. P.O.Roa 2OD9,Sill-CA 95201 �
<br /> ` ['E 4MCUNT DUE AMOUNT 9FMITTkD Cn6H NFCENfi;a, DATE PERMIT NO, �1
<br /> IN[U
<br /> L
<br />
|