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APPLICATIO% FOIL f•f.nMIT NT SAN JOAQUIN LOCAL HEALTH DISTRICT p-EGM,� -0 16+01 F. H,.ZELTON AVE.., STOCKTON, CA R Telephone (2091466 6781 q �9aa PERMIT EXPIRES t YEAR FROM DATE ISSUED NQV HEA�TM ICompletin in Tupllcaco) -- - - p�VVIROh,MfENERIV�+St( APphr.alum r,hrvnv^..'1••f..oro• •.loaryrn LorPl Health D,tnlrt for a permn In era,saacl dnd-m Install the wink herein it C" gpy�FMS� mann m Cone J........o....'..... i...n r I'nunn Onl.nyu a Nn Sae for tinwaxn m No Bw2 till w,•II'Pump emit Ihn Rules a+A ROIPAebnn ,l ma San Joanoin lMdl Nn,p•n 11 ter..•/1 I (�. f /� j I I K Job Address yoo NC7✓5 l�L'_J_µ�R- J/-`'J _ I .Iv 114I&ACI - la Sue_L'4�S PM L�_ TndJShri �k Q: Miilftg�oo(7 Owr«.I's Nam. �.J�Cf�/ C�CC'ts^c+Y1/C3 - nn•I.rts �l n.1.� L' I .p� 1l�,nSwe7L IRd. Contractor}!a'}lhh_ L-ll�rt1/��7__ _Address [�vv I r .W ��' �y�f!l License No.]_S _Phone TYPE OF WELL/PUMP NEW WELL i 1 WELL REPLACEMENT ,' DESTRUCTION i D MC1 �FE, �A JI� PUMP INSTALLA�IION !1 SYSTEM REPAIR ,1 OTHER x ) DISTANCE TO NEAREST: SEPTIC TANK _.aVA -EWER LINES .L _ DISPOSAL FLO.N� PROP. LINE/ & FOUNDATION _#Z.. AGRICULTURE WELL AA.— OTHER W,LL�� PITS/SUMPS A* INTENDED I1SE 7vPE Or WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS_ q 01 Industrial Oil . o iom �Mantaea Oia of Wxa 0e vatq Dia.of Well Casing �l,meg/ �� U Domesti.r Private Y. er'Pack Tracy Tvpe of Cosh+g Ley Specifications t of our Kb _! - I ,b!ie. ' Omer 1 ! Delta Dern of(.emit Seal �N 3� y- A. - not Appro.. Depth I I Eastern Surface Seal Installed by_ - Repair Work Dane 1 1 Type of Pump -_ ._. H P. _---.— State Work Dune I I Well ih,ameter Well Destruction --- - - —'----- Depth ___ Filler Material(Below 50.1 TYPE OF Sr PTh: WORK Nf W INSTAI IATION 1 1 Fit• A41,AODITION I I DESTRUCTION I I INn aapfuz system permnred d I. fee sewer Is available within 200 feet.) Installation will somr, fl soionre _Nmsmt. Other --- I Number of Iiwne,units ___.. Num Character of soil to a depth of J Feel _.___ ---.--Water table depth SEPTIC TANK I I Type/MI -_.___ ty No.Compartments PKG. TREATMCNT PLT.I 1 O Method of Disposal DistomaQs" ' F tbn Propery line LEACHING LINE 1 I No. At that of time ___—_�_ _.�— Total length/sirs___ FILTER BED I 1 Distant a+ ns11 Wall ._ Emendation _ Pooped, Lim--.--- - SEEPAGE PITS DePlh ill -.. —�'- Number -- SUMPS Dnlerlce to meatus e6 _. __ OunQ1lton— .__. Property Lir) DISPOSAL PONDS 1 hereby certify that I hove prepenel this application and that Ills weal,will be dome in accordance wilt,San Joaquin cmnty ordinances. state laws. and lutes and regulations of the Sm,Josnue,Local Health Dlltlwt. Home owner,a I,c...ner aanm's sgmenure andles the following:"I certify that in the Isadormancs o1 the work for which this permit b issued, I shall rot employ any po rac,in such manner as to became subject to workman's cores amfetion lavas of Calilorns.'•Contrmear's hiring or sxbtontracting W."turs certifies his following:"I cnmfv that in His perlormancs of the work for which this perrnit Is issued.1 shelf empty parsoos subject to workman's camp+nor lion laws of Cleformn.•• 1yp,d se, The applicant V. cell for all rkd Inspections. Complete drr+Jmg at resarse$kN.alt I77rsas:M,at'�A'/Ga1'/I j. Signed /� may-/ TItM: �MFJe'�_ -TGs' I A ,� C _..__FOR DEPARTMENT US�:Y t 0 Arora AppftatNd AttepuA nv -� 1�J.•�--/�.�/ �"/*t / . Ph a Grauer Irrapect.on by _ ` _ D:r.- -___ Fatal Tempi M / L — Date 1 Additional Com,mwnts --- LI Stk W treat ! I Lod, 70-3621 Ll Manteca 87z 7104 0 Tracy BTSdFJ&'f Applkanl- Return all copies to: Emdronmer.Tal Ha.Im Permlt/5- cea 1601 E Haratun Ave., P.O. Ba.2009. Stk., CA 55201 ffF MOUNT W[ AMOUNTRFMIT't0K RECEIVED aY DAT[ PFRMn NO —,Isr rerv �w