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SAN JOAQUIN LOCAL HEALTH DISTMG-T <br /> ;,-Ir' ZE...i'0N AVE., STOCKTON, CA <br /> Tolephone (2091 2 0 <br /> pj-fjNjj-v- uXPIRE-S I YEAR FFMhri DATE ISSUED <br /> Apfilicilfi0s, I!;JiMP-11Y f`111111" in tbu �';lo 111r.111j, jij�;!,IcTt for a jii.�Inln. 11, vil.lsk ll'!wIt'l <br /> made in con)JAillico With Sate.1(j.jfptjsl('rijitli rjf). mo im ::Mv-)lw ill Na, 1862 101 WCl'/j)lll1lP illt" titl: ltv13tOal.luv,a. 1ho <br /> City Lot SIZO: J` <br /> Job <br /> I CM5 Ar-11C-1-00MEArf— <br /> ,2 <br /> WE[ .1-h4t N r I 01--Sl lit IC I 1A.)M i j <br /> Nt W %Alf t 1. 1 M,Pl A( <br /> TYPE- of'- WLt.13PLIMP: i -II "fiffil I I <br /> PUMP INSTALLAPON i I SYSTUVI 11171"All't i I <br /> -ST SEPTIC TANK SEWI-ti LINESDISPG.SAL Fl 1). <br /> rUift <br /> Dt.STANCE TO N j FAR.E.- -)-I lit-it WFA.J. <br /> FOUNDA110N AGMCM.TURF WELL <br /> INTENDED USE llypc- OF WELL PROM..Em AREA C-ON-STRUCT10N St'kCIFIGA.IifjNS <br /> Dia. of W01 FX(Avdtlal Dia� of Well <br /> I Indostriat I Often ilottoll i 1. Typf. ;)t -SpetAicat lot 1-i <br /> I Domestic/Privam. 11 1 Gravel Pack <br /> 'I Public <br /> I I Typo ol flumv it t, Smic Work Dont• <br /> l <br /> Repair Walk Done <br /> Well Destfkjctinn I I Well Dianif-lor "AYI <br /> 131tv.111 .-,. f iqui <br /> jyjq. 0j'L IiJ.PTIC WOM<: MAN INSIAl I <br /> I ION 1 1 f1I.,-,IIiw:'i1()N I I M ol.tu :P!l,1?W V, <br /> L-Israllation Wil! scnuHer ;;dfs;Wct, <br /> IIm <br /> Nondim <br /> tv a 41itplll -0 walm.3 itwl: <br /> 'TicCi <br /> SUPC TANK ';?4, ccoavua It <br /> PK(;. F'ffl-.ATMFNT PIA. I I <br /> Wel <br /> 70 <br /> C) <br /> L 1EA(,'HING UNE. No. & Lo-sigitl of lifws <br /> FILTER DED Wf'.11 <br /> :7 <br /> T. <br /> SEEPAGE PiTS ----------- <br /> SUMPS i I Distance to nt-.arast: Vv*ll <br /> DISPOSAL PONDS <br /> I horeby curtity II)at I have 010$113TOd this iripph,tljifjn istl(i that oiv work MR bio done, its acrordaelc;(: vvitil Sart Joaqtj;J`l <br /> niles and raljulafions(if tile $all Joaquin'Lucai ticanh <br /> vvinq: -I CaTlify Illat in the portormaricli of the worl( for which tl!;�;posmll Is ts�wul , <br /> ljorne owner at liconsed agent's-itifIRIUM MrtifiPs ti3l] 41110 corttahirinsl of%4-�r� <br /> Wconle stIj,joT.f to vtoorUman's componSafi()n laws Of Cafiforrlia.- w.l.or' <br /> employ any pamon in such manner as W t r 'm vo�jh-r,.-Irl'�,. <br /> 93 1110 f(Aawing; -I cpijify thrit in IhO Pufformane-a(-�,(110 WUF�.10F'A'hiCfI this[)Or("4 "Y;jjed, I% FIfYiploy P4�ls-.0PS U! <br /> lion laws 01 C?Hifofjl- <br /> etl-j.�t <br /> The applicant mu or all fo o;ppleta drawili(A on roverse sada. <br /> TizData: <br /> Signed X--- <br /> I <br /> FOR DFPAf4TMFNT U%E OMY <br /> Application Accepted bV ------ <br /> Pit or Grout Iftspection by final lr!-'T)43C.tiq;n hy <br /> Additional COMMOnts: <br /> Lodi 369-3621 <br /> ,a tL�'.jqj(jq [-7 Trauy R315-6,335 <br /> Sjk 466-6781 1-3 <br /> Applicant - Antum all copies to- Environrn(alit4sl Hnalth 1,f)r Sotvirog I(jO.I F. 1-Inrolton Ava- P.0- BOx M)3- Stk— CA %2(11 <br /> X.MM ily DAT E PERMY! 'NjO <br /> IFEE <br /> AMPUNY OUIE ANIMMY 11EMIr-MD <br /> INFO <br /> ry N <br /> EN 13-74 MV /W A�- /. Z-P <br /> 7A <br />