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i • A . �sPPLtCAT10N FOR PERNUI SAN JOADUh I LOCAL HEALTH DISTRICT ` 160-1 E. HAZF:i�N AVE., STOCKTON. CA Te:ephor.e ;20914-36-6791 PERMIT EXPIRES 1 WAR FROM DATE ISSUFD (Complete i'1 'rripficate} Application is heroby made to the San Joaquin Locat Heal:h District fir a perroii to cn.•srruct ortdlnr install we work herein described. This application is made in cosrplorica with San Joaquin Cour„y O.umdncu:d0-.549 for se-waoe or.Vo. 1HQ for we'r'pump ane the Ru!as and Rej)ulavons of the San Joaquin Local liaallh Dishier. Job AttdresS GRant Ave. & I-10ffat I31%.-d. (229 MOffaJ ^,tyMcllltL?Cd Luc Sire _ PM 001dentrain - � # )357•-8400 Ovr..f"s Name _- _w- ±=:��r Address �_� �� 1 $tom. SZI! �7I1 Phonn 1- 1901 HaZ.YARD, Ste. 140 Cuntra_IdGLC+lg '�}�F+r `I'� rAddrrss �4 }3729700 _ .nQllxj} Lj License No. rru�b TYPE OF WELL/PtMAP: NEW WL LL I J wLLL NEPLACEMEN- 1.-.1 DESfAaJCTION !_I - PUMP INSTALIATION 0 SYSTEM PFPAiq 0 OTHER ❑ DISTAN.' T0-IlLAREST: SEP".W TAN- SEWP- LINES —]eft,.__ DISPOSAL FI.D.. PROF. LINE FOUNDATION AGR+CUL7UF:E tvELt _ OTHER WELL_ PITS!SUMPS INTENDED USC TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIiICATtONS 1" 0 Industrial U Open Eottnm ❑ 94anteca Dia. of Well Fs^av4iiil;i.LJ_7 jtr Lria. or Well Ca:isut f7 Domesr;�/Private ❑ Grv,. Pack ( Tracy Tyner of Casing nOM _ rspeeiLcatipn. f'I PuhGu =012:er 1 t Delta Drpth of G,Oct �-Iedl _I Of Tyli.el GmwbeJlt4'1;to—._ I',t • I 1 irrigalw.rt P.Piwo4. Depth I I East.ffn Suilare 50.0 Instaltad by fitepxii Work Dune iJ Type of P.rmp H.P. Step We k Done— _- Vfrff Dewiction ❑ VA-,?Piamelcr Seaiing i.Arletial flop 50'► _ Duplh Filler M;alat al iBulcw 50'J 1YPL:OF SEPTIC WORK: 'dEYJ ItiSiALiATIDN f 1 ALPAiRlADD114�:� I f DESTRUC7IL.'d I I If+o s.:p•i; >y-,ton winulted i1 pubGC Sewer is u�dd•¢r,•IJ nrt;an st1t1 feet.I Inmimion will serve: Rerdence Commercial— ^ 1':, Other h.: Number of tivinQ units: Number of bedroon.s Charmer of soil to a depth of D feet:_ _—_Wattlr table depth v? SVTiC TANK L-J ?ypelMlq _ Capacity_.._. No. C.,-,p,zrrrr.ts �_ ^ jPKG. TFiLATdIiFNT Pr-T,n Vethod of Disposal i Distance to nearest: Well Foundation- Pr::peny Line LEACHING LINE Cl No.L Le,grh of linos _ Toral lengthlsita_ FILTER 13ED 1] Distant to nearest: Wall FouridaIion Properly line SE.'PAGE P11 s I t D•tplh —_ Sire _ tvumber SI-IMPS Ll ?istance i)nearest: %%ell—� Foundation Properly Line ] ~< F! �l _ D;SPO:;AL PDIdOS C7 I hetrby renily rlat 1 have prepared this application and :,rel lne work will be Junn in accordance with San Joaquin county arr'.nancr sta[o Laws, and I ruler and regular"i';`w Sen Joaquin Lout He-V!:, District. a Home owner or brarmorl alle:n'a Iho Icllowing: -f ceniiv that in the performance of the vvxA to,vhich this parmit is issued, I shallnot w 1 ernHioy any pmrso n L9 such manner as to become wbtoct to wntkrtrn's compensalion Laws of Cablwnia.'•Contrrr:tor•e hir ure cartifias the ic4owinp:"I comfy tha•in the performarxa of the w,-.;,tot w rich this purnvt is issued,1 sheis shelf employ poisons subjeiry ct to woorkrr.mracanrsnc er ns.t {ion laws of Cu6fornia." « y; The appliCia must rat)dot all r ur:6SI in,peCliOnL. Cionpiale drewing ori ievarsp t;oo Signed JC—/ Date: r _ FOR DEPARTMENT USE ONLY Appticatior.Accepted by Date —. Area _ - Pr[or Grout It.spectiun by Drta ^C 1 f', Fir:aJ Inspection pyj•' := Date ^1 Addiliw..al Commenit: i.'�'1'a-ice- . �•-' .' .=� E7 Stk 456-67$1 b Lodi .76.4'Zfi71 EJ cY i Aaplict'tt-f?oratn an Z:cai"+l 10-: Environmental lien'+h Permit/Cervicus E. iisrnl;nn Ave., P.O. Box 2(Y>3, r..tk., CA 95201 F`f AMDUNT DUE AMOUNT RE"Ir1:p BY DATE PE RMll"H7, � f • S' S t..