Laserfiche WebLink
,^ - <br /> APPLICATION,FOR PERMIT <br /> SAN JOAQUIN LOCAL,HEALTH DISTRICT <br /> 1601 E• HAZELTON AVE.,,STOCKTON, CA <br /> 'Telephone (209) 466-6781 <br /> PERMIT EXPIRES 7 YEAR FROM DATE ISSUED <br /> t 4 <br /> . r <br /> A v (Complete in;Triplicate), ' <br /> Application is hereby made to the San Joaquin Local Health District for a o <br /> made H compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Re ulatf <br /> Permit to construct and/or install the work herein described. This application is <br /> Local Health District: I <br /> Regulations of the San Joaquin <br /> Job Address 2 �{ <br /> City 1 7 C t�. <br /> Owner's Name - ' <br /> Address - Lot Size PM <br /> Contractor ' <br /> ! Phone <br /> TYPE OF WELL/PUMP; Address P•Q. I4S0 <br /> NEW WELL ❑ Li`ense No. Phone D <br /> PUMP INSTALLATION ❑ WELL REPLACEMENT ❑ - <br /> DESTRUCTION ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANKSYSTEM REPAIR ❑ OTHER ❑ <br /> SEWER LINES <br /> FOUNDATION. --- DISPOSAL FLD. PROP. LINE <br /> AGRICULTURE WELL OTHER WELL <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS PITS/SUMPS <br /> ❑ Industrial Li Open Bottom <br /> ❑ Domestic/Private ❑ Man~ race -Dia. of Weff Excavation <br /> ❑ Gravel Pack ❑ Tracy i Dia. of Well Casin y <br /> 0 Public Type of Casing g 4 <br /> +.�❑ Other ❑ DeltaDepth of Grout Sea! Specifications <br /> L1 Irrigation `_;Approx. Depth ❑ Surface Seal"al Installed by <br /> Type of Grout <br /> TVPe of,Pump.• <br /> Repair Work Done ❑ ' ' <br /> .. H.P. <br /> Wel! destruction ❑ ` `*.: <br />