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A <br /> ' APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH pISTRICS ; <br /> ? 33 .x . ... ; <br /> ` 1601 E. FiAZTOH.,AVE.;:STOCKTON; CA <br /> one <br /> PERMIT EXPIRES.I.YEARvROM;pLA�TE.1�SS��UyEQ,}: <br /> .k'J 41.•' 't:l)i��.-,}ti.J:.) Jt.� .....<..�I A �'.I:.���.r. . S .4i�.1[�1W <br /> Application is hereby.made to the San Joaquin local Health 64triet for•porn*to eonstruet*w or fttatali tfia work dsaMbed.This spplicaticm is <br /> + 'rr►ede' S ip6ritpF4tiCa.it�tDti Sari Joaquin CewntY Ordrrist►gta No {gr serra�:�fr.NO.186,2 fl�M wail] d�e�Rtiks art0 Reiputati�rr�of.Cie Sayn�tJoaquin <br /> .� <br /> f <br /> TYPE OF f wELUPUMP•; r 1,rvEw-WELL.D WELL REf'LACEMFJIT L J. <br /> r fl 1 <br /> 5' ?, ' t -- 5Q UTFiER <br /> PUMP INSTALLATION -:. SYSTEM f EPAIR;C <br /> DISTANCE ToNEARESTSEPTIC.TANK SEWER LINES s DISP�SAI;FLD ;PROF' UNE <br /> .r , <br /> FOl1NDATI0n1 AtflICII�TtFfif WEt_L k _ oTHEIt ifYEL�L{I'FTS/SUMS` _. <br /> INTENDED USE TYPE OF.WELL PROBLEMAR, CONSTRUCTION SPECIFICATIONS" <br /> Industrial ❑ D Botttxn ❑ t�santectir <br /> Dim of W44 Exca+ratbn_ t- >' ' Df� of Welt Casing _ <br /> ac: k ri >� <br /> D Domestk1© ji <br /> Gravel Pads r' Trac <br /> R <br /> Y 0 PublIC: F `k C .� { . fl. Depth of Cs[xaeYt of : <br /> Depth O Surface lrret>! ° i <br /> Fie Worst 'C3 T `of Pump s Stn Wolk DdiE r }"rt <br /> pair. D", YPe , <br /> I A) Well Destrttctai ] 11Ve&Dbrtieter Maeeriai r* t _ sa S`>� <br /> 1 TYPE OF,SEF.MC WORK:'m NEW ALLAT REPAI Di-- N_ d�lo.asptic strtteni'p6rtnitted. pabhc sewer <br /> } s, a,ae"ble.wi'thin 2Ufl <br /> r V I S Y <br /> �.irtRaL ' „netr►p i5 t.� ,.Cotr+rrtercis< t S �, <br /> - <br /> ' Number Of bedrooms � r� .�'}} 3• �a <br /> Character of sa to a depth of feet Water to depth <br /> SEPTIC TANK,_,.” 11• T /Mfg ..i'fa.Corrkperdrtents <br /> PKG. TREATMENT PLT.D Method of Disposal <br /> t' Di to nearest Well Foundation late <br /> LEACHING UNfs` i7, No a .of:f+ines'• Total broth/ 1 t r r <br /> • Y r ... r <br /> '. FILTER BED j Q D 7�to neareai Weq Fotindation PtopsrtY <br /> 4 �• kl. .jai 1�L,.in',- 'Ftzn .`Ig �.; ir- .� E: '} r�-t.., 'if <br /> ''• -� 11'S.`l.F Y _ _ 1 E r hen S Y.'!' _jj t_ ) . <br /> t SEEPAGE PITS Q" De Suer a:' �Mu^+bad <br /> i r '. -*, f ,r -�„} ,l r'1 -.i.,'�n.. -....a ��' _"1"��•r1h' � Z, <br /> DI5POSAi <br /> _ <br /> that`the vtii i�rill be done tn''a000anips" $6rtoaquut oot[n!Y state laws, and <br /> l hereoy cerirfyat ►ava preps this.81 .. �. <br /> rules and requtapona of tfte San oei}uNt Local Hes DIsMCt:• { `' �s <br /> Horne owner or licensed agent's nature certifies the folowing I certNy that in the penfomiante g,the work for nAtieh tufa pemtit a rssulad, i shall not <br /> -ernPiOY sty.P'_ '. AR to beco"3Ub)eCf to w Irl'i 1 E'OOfM1p9�1BetlOF7#FIYYR Y!f 4 _Cilli -wA COR1ti8C t fi Ot' B. <br /> e [ t nrtifiea tt►a f "t oe[tffy I t the paA�nce of the work for uvftgh of pemdt is ieatre2!'L MnPbYJ Or R e.c«rkpensa <br /> 4.�% r eL �---•? r ..'., t ,r '*_' .* .� v ? Y r r� ,ly` �+^c�"a �ty� �V' _• <br /> _} Y <br /> A m, <br /> RgzfAm <br /> n i. -W.'�.-,.. <br /> . :dedetionaf'cwriit;irtta.., •` �°'� } .x. .,�� •,�'� <br /> f Sek 5878 Lodi 3 31i2f ( s:82 VO4 r <br /> Applicant Reft4h all copies to. Environmental Heatth Pwirih S�rvroei 1I60t fi HaYeltati' 'F'.OL Stk.'CA 86261� M' x <br /> -i AMOtJMT DUE ANit7UNT ItC�lli'[7ED CASlf~ -.. f: �, ' z GATE _PERNNT-No. <br /> , <br /> 2- n- 101c",< <br /> EN 1426 <br />