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APPLICATION FOR PERMIT <br />�, <br />SAN JOAQUIN LOCAL' HEALTH DtMICT <br />1609 E. WELTON A1/E„ 'T`OCKTON, CA <br />UspNm (209) 4W -Ml <br />PERMIT EMPIRES 7 YEAA fROM � DATE ISSUED <br />I {Cc inpWs in. TriOkm) +t .,+' > -wo 4* ot to <br />Application is hereby' made to the San Joaquin Lam Health Dkwat ftx a permit to construct snddor Install the work he n Assatisd. T46 appkedw is <br />made in compliance with SanJomukn County Ordinance No. S+E1 tawaw or. No, 1882 for vaIwotov and the tvtent end Requiatons of the San Jo sow n <br />Local Health District. •. � %.,, , ds. <br />W.. <br />(7,Nr4r'S Narr>e: _.y AddressA".. <br />ow <br />C�ntraGtM AtIA.— w <br />'TYPE OF WELLJPL IMP:_. NEW WELL 0- . V r.: REPLACEMENT ©r - f3 <br />_ PUMP INSTALLATION 4 � �+" n� SYSTEM REPAIR t7 w � MER C3 <br />DISTANCE TO NEAREST: SEPTIC TANK SEMS LINES DISPOSAL FIA,..Pim. UNE` ----- <br />i i7NDATION __-_„. A+3RtE 7i„TURE:WOTHER WELL "ISP <br />INTENDED USE TYPE OF WELL PROBLEM CONSTRUCTION SPECIFICATIONS r a 1A <br />_i Industrial In Open swla rt...r-•'""C� Mar�taca '*A 10s.of Wall excavation Dia. of Well Casing <br />C art/Pr� tTracy <br />spedficatiors } <br />Public 0 Other d Deka `w, of grout Seal Type of Grout <br />Cl irrigation © �o4,�r4,r $urjacs-§ Installed, •• <br />Repsir Work Dons ©- Type+tf Pump� -L.,% � wig.'. -c. -�4 gate Work <br />Dow. ' <br />Witi3estruc#hart ©., W i� iNtmterf tea StY)f`x,34 __ r <br />Depth <br />071, OF SEPTI' K- NEIN INSTALLATION E REPAIWADD ITiON 09STRI XTION 0 iNo se#*� to".) <br />if w w is <br />Installation will serve: Resklet" -- Commercial the <br />a <br />Number of living units:. Number of borooms, <br />Character of soil to a.dspth of 3 feet: `� � "lfff41W W* depth <br />SEPTIC TANK ❑ Typsimfgat Csparcity t No. Compartnwas <br />-- <br />PKG. TREATMENT PLT;. C ""' `'`- Method of Disposed <br />Distance to 1 <br />F, Lira <br />a <br />LEAC14INGLINE.Cl No. & Legth of Bn &IeT lengtfil�``, <br />FILTER no , U Distance to neweer: WeEI � Fpund"on et� Property <br />SEEPAGE PITS Depth ._._.Sire [+ilrmi:w <br />SUMPS 1 Distance to nearest: Wait FaunrJa t its _ ProporIl Lit <br />DISPOSAL PONDS U L �../ <br />i <br />I hereby c a tiiy that I have prepared this application and that the'wtA will 4ae iona`l t eCCcfrdar►&elft `SM J6ih county bidinarmes, state lavers. and <br />rules and raoutations of the San Juin Lei Health OWa. i ,. i � a ,.• �t <br />Horne owner or ficansed agent's �aturs i�tiiiers the �: "I s ariify st4init pertorrr�nce of tfie •worii ••ittr wininhvia p is isf . I > not <br />anY person in such nano r asto become subject io wodman'sjoornpsmtIoq laws of C.alftrnkL, Co ntr oes Mr�t� or #tiln�� tti�abare t <br />t ..,.,-.. r i;he following: "I ann►tifnr that In the petfarmarioe of the work for tPds parmit is astaed, I aAl wTq)W WW* VA*wrtCo wt>&l aws cornpers' <br />of t,�fornia." £.i '�i• � ,rarLkr',�3�' x � I <br />n Th6 must Call for rarer i CwVlerta drsing tn1 <br />t ; Apol Atm 1 <br />orGnat t` . <br />� .�.-... i'f30n �....... �.,.---..,r-.w 1. • ....r � .d '. ,�......:: A:1�`rMl' +Nt by <br />Additional Comments: �-y <br />13 Stk 466M- G Led 389-3621 0 Mem 123-; +ACJ T"-,,, f!�' <br />Applicant - Rtitun all copies tm Ernviropmentel Asalth ParmitiSeavYCaie 801 E, He do A, <br />. EN M24 tt&V. list <br />0414-20 <br />P.O. slii . CA9 1 yiy <br />' 1 7 <br />INFO <br />AMOUNT t3t7e <br />Atnt ws f rro <br />CASI4 <br />CEiM ByL1r17E' <br />PEftAg7"fflil <br />