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<br /> AFPLICA i iW3 =tis; PEArAIT
<br /> SAN JOAQUIN LOCAL riiEATLTH 0;i init-r
<br /> 1601 E. HAZEL T ON AVE., STCC"TON, CA iVQ�.a�
<br /> Tuiephono 1,2Gi? �� . 10
<br /> PERMIT EXPMES t WAR FROM DATE EaS`cJEu
<br /> iComplete in Trip!"tts't �\ '• 4 4�X t
<br /> ApCtication is heloby mads to•+��San Joar;uin Local HoLith l?iatrict for a pArmi:to crr>szrua3 a►d/o ins oli the work IwKeirl dseoibad.This ti�i;73ka:tOa .
<br /> made in compliance with San J W uin County Ordinonce No.b49 hu sewage or No. )aQ for"/Pump and the Ftuirs tmtd F4ayutet onB o4 tAe blwa kaiquiR
<br /> a . Local Health District.
<br /> k. Job Adartxs �iL/ �' l;l � �s1r-���r----_.__ C,eys.��`- �� i
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<br /> Cwner's No e_,!_��J,f�y��_ Address
<br /> • Cor,traclof— f� /� - A,uress
<br /> 7YYL OF WELL/oUM?: NEW WALL O WELL WEPLACi:MEN O Q7 STALICTQN C1
<br /> r' PUMP INSTALLATION G 14YSTEPW AL-PAIR O 071iut (� w
<br /> DiM;ALDNoP.UN
<br /> O NEAREST: SEPTIC TANK
<br /> FOUNDATION _ ..._ACi?^iE,ULTURE WEL;. �..._ ^.'fitLid 1 .4f.s..._.�.�_.�.... PIZJIJJ3s:P5
<br /> INTENDED USE TYPe OF WELL PROBLEM AREA CONSTNUCT:0W 1,iPECiFICAT904NS
<br /> O Industrial O Open aott m (a Monteea Dis.of Woll Excavutipn Die.of 4�feL Geaitwy '_':1w
<br /> L] Dorrwutic/private 0 G.svel Pock O Tracy Typo of Cas»t�
<br /> Il Other n Oclta Dap:iv oz Gr'-4z r+si TvPv of Grow
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<br /> t� Piktic — ,
<br /> I J kiivatrurt _.AVprox. Gspi,t I I Erica,.: Surf."3"1:.wsialit,(0 W_�� S�
<br /> i\4hsir'itiook Done U Type of Puna h.°. stew Work iraae
<br /> Wjr i i3uatnrceion C1 Wuu Dia►•leter So"ilj ivillizeria.1200 f."i �, F
<br /> Dopth
<br /> TYr�t..t1F SL'TIC WORK: NEW iN57'Ai.LAYiCaN l t REPA:RIADDITWN 1 1 i3[SiP:."G'ftGntii L , rtic a riUr^r `'
<br /> ` ✓ vrrvktcad a psetNia eeraes is ' ,` ,,
<br /> evsJ:staie vkfle7,ifR'19wt.1
<br /> iralRrwn te.0 Sano: Residaatoe Ca:asvtltrC:tl_ i3wllur
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<br /> f�u,ath�r or rMw)urtits:__._ Kurz:?a r of ianvroclmc ._ q a
<br /> Cl,sracwa(v awrl to a del)eh of 3 foot: Wale.,It4hic doth
<br /> LC TA,.X G "fyaaellKld Cf;,rttr; iso t CttyadN cuAYtt'
<br /> yi: +t'�u,`ii►e::b"t"kfi:niT PLT.,CJ......, iti.Ls6hud Qt L''i�;msitt �`` b.,
<br /> (Jiatir1Q61 1i:foeed'4.x: Y'fY7ii _ _.. tu�,r'�:aticra e'ut�ty Llew {� a•J
<br /> ftRi� O No. 1 L.uvp5t 'tswa. 'icwl is ;L�d:2t 1
<br /> f Fti.,T:"ii+°u ip'; O Qiaancr tO IAWP,,U: Peofxrty L:na
<br /> 515121 a;A F lYs I 1 Deyxh Sou Ks rrtber �. t
<br /> d t!lvii?�i L1 Dwtance to rwtariit: W4.J _ Fw ndateovr Pfoprcrfy Lim
<br /> i Mxrat.,r cmr_;fij that 1 have propersd awmf teat Jla work wW tae cr,M in hcrwduicii with Saes Joaquin eauuy ord"umes.alate latews.sad
<br /> ruletr brwl ro.gudations of the San Joxl'eIn LrW 3kd7r C. ALrcct. t
<br /> ti� H.t' c:atnsr w Ikensod agoit'e adg,utura car-t. i s'ru Se:<wvat,;:"4 o oniiy tnM Ir,'.*,utr'onGXIA of*14%*36 for Wfti:A ttA Wnwt IS Lw4ad.1 shat tot—.
<br /> n?nrti�y any clarion in such manr*r as to Wcarwa xarbi wx%to watCrrwtt's corr ixs:utmei+:n Ltrwe rf Cid fnrrt a."Gxltractots ItilfrtQ W Sub t+ontrrctirta si setup 1°r.
<br /> cer^i';x e`w rrtrrarin;a;"I certify that in tits jWtomvr4Q of cite work fw whichif ua pvr.0 u 4"0,s xia+il arrOvif ionone visit ret to warftms s con4wWww.: ' Vis;`
<br /> fon{rtaw of Uif"Ma.'
<br /> ,. Tivir&;oiicam mint cell fa all ry irsf dwuWKt wave. ri:omgtata drewN on rvvwaa ate. L
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<br /> Si�►ned in: .�
<br /> A pilcmlbn Accepted by ('Y•t`awA �•w':,�¢L yi .. D/fe �r o ASM /O
<br /> 1 Pit or Grout Inspection by_ �) �. Oaw i-insl liuwtian by QIMe
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<br /> Ar9dii+Ortia!Cxrmsna: _
<br /> O Stk 40a-0r111 O Lodi '[118.3625 O Manwca U:i-7104 f7 Tracy XZ-BU- 6
<br /> Apoi:ant• Ratum all copies to: Emrironmeniai Heatih Piu-miviSaVk""6601 E. Hazelton Ave.,P.O. 6w;b04,6%,CA"I
<br /> FCC I wlanUNT DUC Ai 7r10UldT i;E11NITTt1'4 V`r� ". RiCEIVCD tiY DAT: i P6Rfrt1T'fO
<br /> INFO
<br /> /111rV,afnefj7,l.�', C1
<br /> !H 14•9a
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