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A r APPLiCA' FOR PERMIT SAN ,OAQuI% LOCAL HEALTH MSTRICT q i� 1601 E. H:7LL7,1% Al.'[.. STOCKTON. CA PERMIT NO. >� relephone (ZD9) 466.678! DATE ISSUED V1 !' a ?,a�_:T_rAo:irs 1 YLAw FR ►t DATE :SSUEO (L.Implete in Triplicate) a ADDlicdti0n 15 nereb/ made CO the tan .iOdgl110 Loeel nedli4 Destritt for a Dlrm't CO CJnSLruCL and/Or install in! atOril Mrl1n i} described. This ap.,ica.ion is mode in car:pliance wite Sar. •:aequ1n County Ordinance No. 54; for sewage or No. 1D62 for well/p.i i ono a Rubs an' R� 1atl�rs 0f the San Joaquin Loc 1 health District. '� .3• Job Address- Suodi+isicn Name 1 Owner's hams — �S ►�_i�i 1.t�y Address _ Cv l L C Pfi01'e ooe Contractor's Same �,'� _�_literse No. - S 1 itiPhone 4 --. el;,Y 1"c}i. "' •hsa=7�a-a:-.a-rra-cs�r:.--c..- ti TYPE OF WELL/PUMP WGRX: ,- -hE'H W, WELL REPLACEMENT ❑ DESTRUCT ON P;M? :NSTALLATICt, 1_j ;YSTFM Rb,lk OTH 9 7 DISTANCE TO NEAREST: SEPTIC TANK SEWER L;XES DISPOSA FLO. PROP. LINT rr �x FOUADA7:U':_ _ ,AGRICULTi'oE WELL OTHER W ll PITS/SLWS INTENDED USE TYPL OF WL_.L PROI.LEM A81A CONSTRUCTION SPEC FICATi ONS Industrial J Open Bottom (`Mantara Dia. of Well Ex vation Domestic/Private C]Gravel Pack Tracy Dia. of Well Cal Ing t"i Publie Other ;eita i+E\:;a .a i :: u Type of Casing Irrigation a-oz. L.:Eastern Specifications Cathodic Protection Depth Depth of Gout 1 GesphysIca i Typo or :.'nlat r �Cthor Surface Sal In tolled by '• i?aj r��''�i z iiepair Work Done(� Type of Pwnp n.P. _— State Work Done ;rte' Well Destruction Well uiameter Sealinq Material (top 50') Gepth Filler Material (Below 501) �'. TYPE GF SEPTIC WORA: NEW iNSTAL1.ATi0N�_� dEPA1W�OD:T:Gh 00 septic tank or seepage pit penoltted if public serer is w s available within 200 feet.) • , rt Installation will serve. Residence )a Coumercia !.her _ » ° 2 i.� Number of living units: _4_ NJmut:r of bRdNOtRS S Lot size U Ch;.racter of soil to a depth of Taut: '4 1`1 111 ~ 1 t Water table depth SEPTIC TANK Type/Mfg Capacity ho. Compartments PKG. TREATMENT PLT. ami Type/M7U _ _ _ _ Capacity Met'ad of Dispusal D;stance to neare., .cl� r�• /Foul lition Property Line LEACHING LINE \. 6 Lento .,f lines — � Total length/size FILTER BED �; U-.ante to rearest cell _ Foundation Property Line �•.Hti;.� SEEPAGE PITS ] :epih Size _y Nu1Mer f {pc J Distante t0 nearest: Nell Foundation Property Line *:? DISPOSAL PONDS Yi•S v-.r�ssr_trnzr�a�•��iif1•a�..arar-. .. ... I hereby certify . at i have prepdred this apPliration and that the work will be done in ace odance with San Joequim county t• +�"" ii ordinances, state laws. and rules and regulations of the San Joaquin Local ►!earth Oistftet. Home ow i-or 1'censed dyent's signature certifies the following: "i certify tha• in the p•:rformance of the work for which this permit is issued. 1 shall not employ an person in such manner as to become subject to worxmanS compensation laws of Cali'urnld.' o egF1r,, Contractor's hiring or sub-contracting any certifies the following: "I certify t iat in the performance of the work for whit V s peri-it is issued. I shall employ persons subject to workman's cam J pensation tarso California. ' i: T L4A"_1CdJt must cal or all r ired i Factions. Complete dr Ing o rse Title: Date: /AD fyDEPAR T USE ONLY Application ActeP:ec by ��, ^ r Ara Stk 466-6761 }. 1' Ad-itional COmssc'nts: 4'.// c'-^� �a.K:f•�I*� p rj div i/�1 a. iJ Lodi 26)-3621 Pit or Grout Insp -tion bf. Orate t_! Manteca 623-7104 ?r'biia't}t F . Fin.1 'nspectian by _.f'lt. '/ .krc !_'a Cute /4 f # U Tracy 635-6365 ;+ + Applicant - Return all copies t;: Qivir~..tal hvalCh P.emlt/Survices 1 E• 1laceltin Ave., P.O. Box ZOOS!, Stk.. CA Will i ►fEC t BASE AMOiI.1 DUE�AMOi"+T REMi",cD——RECEIYEO BY I DATE PERMIT N0. INFO r---}--- ' spy•F:, l l .'1 ti .�� .I !, i�l i