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Ittstal78trt)r� will sense: _____ Catrttrtnrckal ........ <br />�#Yt WE <br />AMOUNTpEfdt7TE1i <br />t.ABN <br />ItECf D.ISY DATA PEAMIl"No. <br />t <br />' <br />e G <br />APPLICATION FOR PERMIT <br />1.7 <br />` <br />SAAB JOAMIN LOCAL, HEALTH O19MCT <br />1601 E. HAZELTON AVE., STOCKTON. CA <br />Telephone 001 466 -SM <br />PERMIT EXPIRES 1'YEAR 'FROM OATS ISSUED � <br />icornplete in Triplicate) <br />Application is 11010V made <br />to the 5nn Joaquin Local Hetet District far a permit to construct andlot h ural the work herein described. This application is <br />Na, 1862 lot weilf pump !the Butes and ftegutatiarus of the San Joaquin <br />matte in coinpliance with San Jraaquin Canty Ovdinance N5. 549 tot sewage at <br />Local Health District. <br />, <br />"' ihl Lot Size PM t <br />1 <br />Jab Address <br />_ Ie • — - p <br />r r� <br />OF <br />Phone 11 <br />Oy�ner's Name _ .._ .. <br />+G� --rW. <br />' <br />tHttfactof —....»,« <br />f i ttaa ZPhone ' <br />x <br />TYPE OF WELLJPLtfd1P. <br />REPLACEMENT Cl � OftyRucTioN Cl <br />NEW WELL iii" -""""OTHER ' <br />w <br />P1JMP INSTALLATION © ; ,' ` :z* \� YSTE14-40'AiR Or OTHER C7 �r <br />DISTANCE TO NEAREST. <br />SEPTIC TANK s "� SEyyER 1lNES___ - {3iSPOSAL ELi3. PROP. LINE <br />y <br />I + <br />FOUNDATION ,AiGR1t�LiiT�iAE i L i�FrrHM WELL PiTS1SuMPS <br />n <br />1NTfcNDED USE <br />~ <br />32jt.INFACATIOUS 4 <br />TYPE OF WELL pRO�l.EifW1 AkeA CONSfRUCTltSA <br />- - — ---— , <br />Ci Ot Bottom © me"" Din~ of Weft Excaval Die.. of we" Casing <br />C IndusUial <br />Speciftcatigu <br />t• <br />Ci Dvrrtesticl Private <br />i� Park 0 7YibY Type of i ••° <br />-••w «• r <br />p <br />ci Othet i i D" Depth a# Grout Seal ".� <br />I Irrigat e <br />_-APlaox. Depth 12 % n Su Semi Installed by ) } <br />ne <br />Repair Work DoC <br />Type of Putter e`H.P..�_ State Wrc Cotte <br />Wad Destnrctiorr LJ <br />Well Diameter Searing material Itop 50'i <br />Depth Fiflw Material IOslor 50') <br />TYPE OF SEPTIC WOAX- <br />NEW WSTALLA I I REPA IAODiTION i i DESTRUCTION l i "bili �7�lU it�f7;w¢ saw is <br />Other --- <br />Mumber of Kiring units: _•___..W. Number of bedroom <br />Chtk wen alµsgap a depth of 34eet; Water table depth_, <br />SEPTIC TANK ` Cl Typeimtg impacitlr — No. Corftprrrtrnents . <br />PKG. TREATMENT PtT,. 0 `tip d of Disposal <br />'opedy <br />DftWiance to nl►itr � Waft � Pr Lirue �.. <br />LEACHING l"1NE <br />FILTER BED <br />4 f l t>f ftrte~ Total lh/slza <br />0 Dist to tie f: WO Fttandstion Properly <br />SEEPAGE PITS r I Depth ti �' 5kle SWtrrttber <br />Si3MP5" 0 Distance to rwb*go: Weft � �Fpntrda ` i •' Property Lama _ <br />DISPOSAL PONDS 0 <br />i hereby certify that I have prepared this appk4tlorr "W't the work will be clone in aceoid nOs with San Joaquin county a ruses• state laws, attQ <br />rules and regufat'mns of the San Joaquin Local H4WW D t�t• <br />Homs owner crr licsrtsed agent's signature certifies Bta : "1 cwrf3#fr that: ' 'pettftrrrnnnog of fife wank fou vrrhicht thin pmt is issued, I elasdi not,, <br />errtplov any parson hu Bruch rreuuuet as to beco"We su to �`a �` n laws of Csoorrdn." Cotmaator's � or t*Darting s�naturq <br />cWtiti" the following. -1 certify that in the psrtorrrencs Of the viorA'for vAkh iii "jed. I >entploV pos su*w to vwkmah's <br />tion laws of Cawarnia." �1 ' , 1, % 't - s AF <br />The appiiaarrt call for aft required +nspectiwu. C to dr~awinp.wi" ss aide~ t r l <br />Tritte: Dow. <br />FOR DEPARTM� USE ONLY 10, <br />"MM <br />Application Act"ted by ` 4 ._ Date tPit w Grout inspection by • Osts Float Inches by iAdditional Comments;ClStec 466-M1 C Lodi 389-3VI © Maw OM -7104 L� Tr III�•B,3bS,Applicant - Return til to. Envabri enti i Hetdth PwrnitlServices 11!011 E. Haa6fton M+e., P. p9m 20M, Sdc., CA <br />efr t3Ie tr�V. r r « m <br />If O <br />�#Yt WE <br />AMOUNTpEfdt7TE1i <br />t.ABN <br />ItECf D.ISY DATA PEAMIl"No. <br />t <br />e G <br />xp r� <br />1.7 <br />k. <br />MI -1 <br />tr <br />