Laserfiche WebLink
VA <br /> r :g <br /> APPLICATION FOR PERMIT <br /> �1y <br /> ! <br /> ' SAN JOAQUIN COUNTY PLIC ALT E VICE I <br /> ENVI�ION7dENTr'tL KTON, CA 95201 ! ,.J <br /> P 0 BOX 20 9, 4 g-3447 <br /> APR R 1991 <br /> Triplicate} <br /> (Complete i>1 <br /> crib ed. rile <br /> �y ya construct and/or lna �{pa of Saar <br /> APplicatloss S+ hereby ta.do to San Joaquin County fora Pc L and 1862 and th rI <br /> t,21ication is here In c0*1Janee with San Joaquin County Ordlnanca No. 5 9 <br /> :eaquib County Public Nealth 9arirlces. f- r.( f •_ Lot ylxc/Acres <br /> (i.��Fi� Lt�E r tit-i_!� CiIY_d Lam_ <br /> iSiS -`� <br /> Job Address ��SS'cti1 SJ �µ�Phone <br /> C t Y�L. G Address FY I' G,_ �f �71 <br /> fwrwr's Name ' S 2LG� Phone L �5 ` <br /> ' Z���: P,__�ACEMENTLicense NO..�46 <br /> AddressDESTRUCTION ❑Out a! Service Woll C1 <br /> Gonuaclar C3 OTHER scInitorina Well A <br /> NEW WELL Q <br /> YPE OF WELLIPUIdP'. SYSTEM REPAIR ❑ pROP.LINE <br /> PUMP INSTALLATION ❑ 5£WER LINES --OISpOSAL FLO.� PITSISUMf 5 — <br /> ��- <br /> DISTANCE TO NEAREST: SEPTIC TANK ___ AGRICULTURWOTHER WELL <br /> E <br /> ELL tr <br /> FOUNDATION <br /> TYPE OF WELL pROBLEI All' CONSTRUCTION SPECIF1CATI Dia of Well Caging <br /> INTENDED USE r-�� pia.of Wel!Ecuvatwn P gpecdicetwna <br /> E1 lndusenal Q t7 Manteca Open Batlom Type or <br /> f Casing g - 4, <br /> Es Gravel Pock Q Tracy /0 4- PI Type of Grout C� <br /> - :JDomaserelpnvap (2 Delta Depth o1 Grout Seat ��— <br /> Q Public 1.1 Other Surfica Seal Initialled by <br /> Approx.Depth Eastern State Work Dona_ <br /> Cl!rr gallon a owrl' H.P. .� <br /> Repair Work Done 0 Type o1 Pump - �� gealiaas Material i D@pth <br /> Nell pestruc[ion ❑ WIN Diameter Filler Material 5 Upth L <br /> Depth system rmillad d public sewer n <br /> *vPE Of SEPTIC WORK: NEW INSTALLATION l7 <br /> REPAtHrAODITION Cl DESTRUC7tON G avarf blsrwllnin 200 tagt.l <br /> Commercial� Other�--- <br /> Installation will serve: Reaidmc umber of bedrooms yVe[er table depth <br /> Number of living units: Na.Campartmeina <br /> Character of goil to a doplh o(3 test: Cspaciw____ ^-� <br /> _EEEEE� <br /> SEPTIC TANK O TypMethod Of Diapoaal <br /> eJMfg <br /> PKG.TREATMENT PLT.ClOiatsnce to nearer[: Weproperty Line <br /> il <br /> Foundation�� <br /> 1 <br /> Total length/ <br /> LEACHING LINE ❑ No.E.Length of lines foundetwn— r PropanY Line---�� <br /> FILTER BED I Distance to nearest: Well�- <br /> Number <br /> 11 Depth ���'Silo property Line <br /> SEEPAGE PITS wall�_ Foundation <br /> SUMPS LI Dinance to nigras[: <br /> pI5P05A1 PONDS <br /> I he, ca PO tear l neve prep+red this SP and Ina;the wars wdl be done In occordancs with San Joaquin county ardin+nceg,stats taws. an <br /> rulestoy ane ragula:ions of Ing San Joaquin County ^l certify the[In the periormancs of the wank!or wnich tits ga[rrllt is issued.I shall not <br /> rioma owner or licensed a0ent's si9natura candies the ibllaw-mg: Isom subject to workman's compenu• <br /> amDlay any r roan in eUcn manna'a^;h�p rsubje t 11h■wor tan's ca ch t1u+tparmrt+i&sued.lI shall amp Oyapa f't nrting or Subdcnlfa Cbng elgna[Ule <br /> certifies the lollaw ng:'I certify that <br /> tion taws of Cslilarnia." s Complete drawing on'*vete@ side. �1 <br /> The appli A ust all for alt required in Date: <br /> Titis: <br /> Signed <br /> FOR DEPARTMENT USE ONLY Aram <br /> ! , •rL Dat <br /> Application Accepted byDate _ -- <br /> Fina!InspaCuan by <br /> Pit or Grout Inspection by ---- <br /> ihional Commanls: <br /> Applicaat - R@turb I'll copies tp0 ENVIRONMENTAjoAqUIN LOHEALTHUDIYISBLIC HEALTH SERVICES <br /> SON PERSTLCy VICCA 95201 <br /> 445 N SAN JOAQULH, P 0 BOX 2009, sT�KTOI <br /> GATE PERMIT NO- <br /> C%+ <br /> £N£0 6Y <br /> FEE I AMOUNT out AMOUNT REM'!It <br /> INFO <br /> t O.Tr rale,u.ei F <br />