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<br /> 1601 E. HAZE;TON AVE., STOCKTON,,CA
<br /> Telephone (209) 466-6781
<br /> f. y PERMIT EXPIRES TYEAR FROM DATE ISSUED ` '
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<br /> Pit § - I (Compli tea In Tripli a e)
<br /> r ;Application ls'hereby triads to Elie San.Joaquin Local Heeltfs District for a permit to Construct and/or install the,work herein descnbed This ap ilicetton iso
<br /> ro made in Complience,vv'rtl San Joaquin County Ordiita No,549 for.sewage or No. 98&2 for well/pumpand the Rules and Regulations of�taqu
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<br /> y F DI$�ANC �Tb,NEAfiP7'1AI INES ` - QISPOSAL FFLO. a. �p�
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<br /> 77, , w f6UNDATiON AGRlC9JL'TURE�UECL } �;� xOTHER WELD
<br /> INTENDED USE£ STYPE OF WELL ,PR08LEMAREACONSTRlCT1flN SPECIFICATIONS r
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<br /> O Domestic/ rIvate 9"i aver P CI 'tJ�ra M= peeifieStiOns '_
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<br /> y Nepair jNork Dorse "Tyi1B:0(Px� �j State�lNarlc DOC►e h ''r x._.�._
<br /> Wel! DestrtiCtion= y
<br /> i TYPE OF SEPTIC4,WOlVEIAI NST T1dN l p IR�fAgt3tTlf3 Y,110
<br /> 10ESIRU TION-10 1No sdpiic�'System'permttt`
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<br /> Distance to nearest: 'Well' i Foundation Property LineF t $.
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<br /> fi�; LEACHING LINE �TI;1 1Va xf1 length of lines Total length/sue
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<br /> FILTER BED d gistance to riearest:""'""Well Poun1'la'tion ""Property' Line
<br /> 41
<br /> SEEPAGE PITS. ' 1 1 Depth,a Sire im Number
<br /> :511MP5 G Distance to nearest Well foundation i __ PreDerty;Line
<br /> . 'r DISPOSAL-PONDS: ! in
<br /> I herebycertify that I have prepared this,a r
<br /> y p Pa �pptl�ation and that the work will be done in accordance with San Joaquin county ort�inahces, state laws, and'
<br /> and regulations of the.San Joaquin Locai Heath Diltrjct.
<br /> Home owner or licensed.agent's signature oeritfies the following ','I,certify,t6at in the perfomtance o€the work for which this permit is issued, I shall not
<br /> ,-employ any person in such nner as O' ecatteAu. ject.to workman's Dort( tion laws of Cairfamia.",Contractors htnng or b c ntracting signature,'I r
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<br /> Ycertifies the following s,I; ghat In the performance of the workCfor which s permit is'issued 1 shah employ persona sublsct o woritman a compensa-''
<br /> i�.l T , .�h M4fr -
<br /> t 1 n.laws of-Californi
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<br /> r ©5tlf ©�adl ,389 621 'C] Men a ffi3 7144 d Tracy 5-63k7-,' ,l 4M� . n x� `
<br /> Applicant 6 Return ell t opica to'Envlroiijitetttel ealth.PermitlServices t6p1 E.`.Hazelton Ave P O Box 20Q9;'Stk.'..CA'95Z01
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<br /> 3 i NFO FEE AMOUNT pUE AMQUNT RE Ep CASH RECEIVED BY PATE PERM7'NO
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