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APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. ISDI E.HAZELTON AVE.,STOCKTON,CA <br /> Telephone(209)466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Cornplate in Triplicate) <br /> Applrutwn a her.hY made to the San Joagwn Loch Nemeth Dendct Ip a pemN to construct",W rn.taA the work herve,dow ib d This mppflu n.s <br /> mAOa n<on,dr.r,ce with 5.n Jc.purn Ca.nry Orylaw.ce Nra 5tl Ip aaw.ga p No.1962 fp MII'g ump and the Ruta and Regulations Of the SM JOpurn <br /> Loch Maanh DalrKt <br /> �j <br /> / 5aG/It a <br /> Joh Addy...__lytEa._7W. Re,CMt�. .P/ Co /­// Lot Sn. 47Eff a PM <br /> 0­N.m.. &,tfE fr�Ada.., Q9e 9 !t/t11}n�i�A/ Ph— gn-sw 9A <br /> Cwj,.cta Adores, L.Cen No.—usl" Phone ydK Jam_ <br /> TYPE OF WELL/PUMP NEW WELL JK WELL REPLACEME I' DESTRUCTION P <br /> PUMP INSTAL LAT SYSTEM REPAIR n OT ER❑ <br /> DISTANCE TO NEAREST:SEPTIC TANK A SEINER LINES DISPOSAL FLE) PROP.LINE des <br /> FOUNDATION_ AGRICULTURE WELL'OTHER WELL _ PRS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> I I WJLOWW Ij Opm Bonom- c1 Manteca Dr.M Well E c&m— 1/aN Dia.of WON Cwq .�. <br /> X DpneeNc/PrWate )gCiaysl Pack Ll Tracy Type of Casmg 0✓L 5pocdcarga <br /> I-I Pubkt 11 Otho I 1 D." Depth of G~See /be Type of Grout SCKttrL <br /> 1 Ynpstm _ <br /> App­ Depth I I Erten Surface .1 Iretaged by <br /> Raptor Wpk Dore I.1 Type of Pump A H P _ _ Stag YWCA Done <br /> W-A Deetructron i-7 Wr Drerroter ___ Seakng Memel Imp SO'I <br /> Depth Fd*,Mateoal 18elow 501 _ <br /> TYPE OF SEPTIC WORK. N-W INSTALLATION I I REPAIR.ADO1IION 1 DESTRUCTIONfNo{epee system pemtted rl prdF aaw.r e <br /> ayad"waMn 200 feet 1 <br /> 1ns1a11melpr wA»rve'. R.4.—__ Commerce) __ Other <br /> -- Nurrbe at Ming unto: N'""'of hefroone <br /> Charecte d sow to a depth of 3 faN. _— Water tads depth._ <br /> SEPTIC TANK LT Tsps/Ktfg Capacity_ No Cornpetlrenu <br /> PKG TREATMENT PLT.❑ Method of Depose <br /> Dent—m neem: Wee_ _ Foetdmem__ _ Property Line <br /> LEACHING LINE ,' No.A L"M of Iarea Tota,4n9tn/tote <br /> FILTER BED [1 penance w'maroat: Wag Foundetlon_ _ AopenY W <br /> SEEPAGE PITS I I Depth __ _Sue Number _._ IT, <br /> SUMPS I.I Detartc.is mesa. Wen F--U,ron P,.p"Irne <br /> DISPOSAL PONDS I 1 tC <br /> 1 harebY candy that I eve pepaed IM apprcat—and Ihat IM worc.dem!w done rn accwdanu—,h San Joachon county ordna ...slat-laws.and , <br /> rues and reg,rla—of tee San JOaou.n r,c.I Hearth CA— <br /> ownsr a k1--d awht's"—fure—If—de 1.9—og -1 Candy the,n the penormance of the won for which the pemt m muted.I sh"rot 1 <br /> - M+,pIOv eny person a,wch mentor J.to h.cone WhIMt n wnrkmeni COmpere.tiOn NwF al l.dlrlpne COnlrattuy'.Iyrng a fuD conNKlmg a,gneNye � <br /> cemlres 1M Ioanwmg "11-1 Hat ro tee fenorm.yw;e I,'the w v.#I,Muco the permt rs cawed.I shat emptor M, n,wbpa t0 w�rkman s compensa <br /> Iron Wvs of Call forma <br /> The appl,yanl n 1st on s elctron C�, <br /> oole a va«nip:n re�e. sme <br /> N <br /> Srgnsd K ., a T na r n <br /> ll ,,FOUTR DEPARTMEN USE ONLY <br /> Apphc~ACtapted by <br /> Grout `` Dela ArM <br /> PK or GrpInspectlolt by pee !f Frnme 1h.o.chon y 4�.L <br /> AOdlbelen Com nsio __ - <br /> ❑S1k 48"M0 Loa 30B 3521 O Mantes 823 7104 n T,.cy 83&6306taMR.4—R.4—r <br /> — <br /> Appg -RCOP-W EmuneteRe HeMth Perron/Servient 1901 E H...Iton Aw..P O Boa 2008,Stk,CA 96201 <br /> �;1�'^ INfO AMp1NT tKIE AMOUNT REWt'ED CK CAS., RECErvEO gY OATE PFRWI NO <br /> P e <br /> .,.:IN fee, <br /> k <br /> ay � r <br />