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Ar"PLIGAI'1QN FCR PERMIT
<br /> r ° f
<br /> N-' SAN JOAQUIN LOCAL HEAL/ii ('l,*-Tk.W1 r tY� ,r•I
<br /> ;COt E.
<br /> HAZE'--,O-'4 AVE_ STOCi(TON, CA I�,;) �.11
<br /> Telephone Q.0N, 466.6'Ti -y
<br /> PE wiT EXf'liit$ 1 YEAR FliC'�n faAT!` 1SS::Et� OCT
<br /> - (io!npime in Tiip,icate)
<br /> gppEiCation rs he:uLy ' rrm'•t to eo+-�struci dnWar install 7hC�(vNr1 hnnin Au-4rib^d.This aPPFieahon is
<br /> made to tf1r,San•tVanusn Local Health D;W'cl for a P 4ii II , >,n Joaquin
<br /> t wade in compGanre with Srn.!u.+nuin Ct,_ay Jrdm.mcc h'n.5A9 tu's,wage of No.ttH,I Int,nrlllRump ono th•• a,WA IS ERVI-C-S �
<br /> Luca$Hear:!'L,.,rrre,
<br /> PM—
<br /> Lot
<br /> South o: 223 5. Mnf._at1�s��ide ofC;;yMantec�^ siee-- (_q f.4' 5)
<br /> Job Address ._-- -._---- moffat
<br /> Goloen Grain Co Ad5le3: :1111 13San LeandrQnor,o 667-617Fl2
<br /> Ownu$'s Name . --, - --
<br /> .1401 Halyard Dr. r. Ste. 1S0 C57 372_47^_
<br /> l4eSt $aC=_�Tf!,1'�1t0
<br /> corutactaGroundw_:t er Tech_h::rr.a.__ - DES1RUCTIO.4 L!
<br /> - , NEW WELL :Y WELL fit.>'LAL"LMI-NT :I
<br /> TYPE OF W"cLL&UMI: SYsTFM IiflPAM D Olt ❑
<br /> ' - -- PUMP INSTALLATION :3 -
<br /> p;SPOSAL FIA. PAOP. LINE
<br /> g -_, SEVJEf LINES -_—.� _ PITSISUMPDISTANCE 7O Nc.AR'cST: SEPTIC TL.N'toN G A -RICULTURE La'ELL UTHFA WELL - _
<br /> FOUNOATI
<br /> - --PF?;iR;.LMnRcA CON5TPUCTION SPECIFICATIONS
<br /> INTENDED USE TYPE OF WCIL ----..-- _ ---- it—
<br /> INTENDED Dia.o1 Well C
<br /> --f L.]Open Bonnet {] !�antcaa Dia.of Well Eacevat•an-7_....�
<br /> �{1 Sndusuial _ Specilications
<br /> r -I Tracy Type of Casmq_._-P_V_-i"I DomcstrclPliva[o ytXGrn,el Park -- Type of Grout
<br /> I1 T-tells Depth n1 Grout Seal u.fL-r
<br /> T � I'i Public I-IUst.cr
<br /> .SQ Ailla nx DcVrh I i Eaa turn Surface Spar lmtelled by r
<br /> I I hn�ation State Work Dune - �44
<br /> Tv+c o1 Pun.p tti f'.� Repair WGrk Oanc u } —`— -
<br /> Maturir'1tcP 50'1r Wei!Dtam..r>terWc.l DstructionpePth _J--_- - f iia$ n {F3a1Gw bD•1 � 41L-';IIlUC11DN I } If"'srtnrc syslonr 11"111/1"'41 AIYPLOF:iLPIICWUfIY:: tll.W hT:i1A1.LFTIUN! I i!E,-FIP�iADDItIU:V' S L ❑v�l;l.,UI�_m�rtt,rn 2l)D Irel.l
<br /> insta'lalion will serve: Re;idenru.-.-. OtherNurnov of l�vmg units: Number of Lwdrooms_ Wd1or[able dePtn `
<br /> Chancre+ of _Ul.to a!�eptll n1 3 feet: -- Yo.Compartments
<br /> _ CaPaulY---.
<br /> a SEPTIC TANK C1 TyT+e11AIO - ---- -"-- Method of Disoasal
<br /> ! PKG.TREJt,_f'•AENT PLT, M -
<br /> + Foundation Property Line
<br /> Distance to ntarest: L'J�II
<br /> Total lenClh/size -
<br /> 3 LEACHING UNE E; Nc.. 8 Length of lines —_. --- --
<br /> FILTER BEA LJ Diltalce to nearest-.
<br /> well Foundation Property Line -
<br /> q -� -.- - Number
<br /> SEEPAGE PITS ]1 Dna,h - - rt Line
<br /> Faundatro:t property
<br /> +' C,UMPS 1.1 Distance to ncaresl: Weil
<br /> ! DISPOSAL PON'JS it
<br /> 11lureby Certify that I have plepai`W Ihr3 application and that lt,e,ADlk will be 110$10 1, dccaidanco with Sar Joaquin County eedina ntes.stern yrws,and
<br /> e*' - rules and,Ogura l+c•ns of the San Joaquin Local Hczilh D�btrict. y performance Of The work 101 yryt'ich this por•rvt s issued,1 sF^H not
<br /> `+ Home Owner or licensed ,pant's srgnGtufo corldies:ha IGllowrnq:"1 's c that a ton 110
<br /> persons subject to workman's comps,Sa-
<br /> � employ!ny pOrsOrr in SUCh menet,a5 10 beCOmn aubtsCt to wUrk mdrl 5 cOmPn nidl,nn laws o!California."Comryctor's hiring or sub-tOnitaCUnFS signature
<br /> . .- cenifie3 Inc 1o9owirsg:•'I cenily thal in the Ili of the work tar which this permit is issued,I sha11 employI14d LOCAL NEA1.1,H DIrTRICT
<br /> tion laws of California;• SAN iC•AQ
<br /> applicant must call Tor all rnqui dins peCtioaS. C^!nplatu drawing On reverse ride. [NVIROhA4i'NTAL }-i)ERMVP�9�
<br /> j ��Y rias: Geologist _ i-s-Z-
<br /> Signa
<br /> FOR DEPARTMENT USE ONLY rn
<br /> nate_LQw�i3?�7
<br /> - T App5ebtion AccePred Area by .Q--�1-�� -'_"-_- • �/{� 7 c�c
<br /> Fine:Inspa.-tion by 1R��-.[u.`/
<br /> Date�J=J_Q�Lr
<br /> 4
<br /> _ D.rre. f
<br /> _ Pit or Grovl,nspectian by
<br /> :- - - Additions[Comments: /} ^' "'�'�X'^-• 7
<br /> xT [ Sts ab6-6?61 [�
<br /> Lodi 353-36:t G MameCa 1 -71fF'( U Tracy 1i35-G3R5
<br /> Appliclill• Return el;espies%0f"90 nmertal ff?eehh Pn1m!ti S:e $tes 1[ySi E. Haxeltan Ave., P.O. Box 2069, Stk.,CA 95261
<br /> > i CK.
<br /> FtE dAl UtiT DL;t ,MCLINT ilE%aITTWFO RY GATE PE RknIT NO.
<br /> ED RLCi
<br /> lc�-a�- -b ! �i-a W 7
<br /> 3:5, ----
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