Laserfiche WebLink
rUr U4 '68 16:44 EXCEL TECH. SE <br /> APPLICATION FOR PERMIT <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT AA <br /> 1601 E, HAZELTON AVE„ STOCKTON, CA w <br /> Telephone (209} 466.6781 y <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISS <br /> (Complete i Triplicate) <br /> Mad 11)ioncQ is Fret■by made to the San Joaquin Local Moalihcw No. District for■perfnlr to construct erW/or rnsla1f the work harem described. This application kt <br /> mads In CwnoE once with San Joaquin County Ordlnante No. $49 for sawspa Of No 1862 for well/pur.,p and rhe Rvlet aid Regulations of Itts San Joaquin <br /> Local Health tl:rr.cs. <br /> q <br /> Job Addteea <br /> City ' Lot Size <br /> Owner's Nab �+ 0 1 C o r+r >,, "° ' 0 9S-;y / PM._-__Nan-41.rd. < P O Zia <br /> �•('..'I �"f t � ►+one 8 '.Z <br /> Cantrrrlti ( f'c At7Qrtst 16 i yN,S.3 S .. <br /> TYPE OF W�ELL/PLIMP:L r t License Ne. <br /> NEW WELL WELL REPLACEMENTD <br /> PUMP INSTALLATION D DESTRUCTION Q <br /> SYSTEM REPAIR pEWOTHER or r ratJ� r,S3 <br /> DISTANCE t0 NEAREST: SEPTIC TANK c <br /> ER LINES DISPOSAL FtO. <br /> FOUNDATION PROP. LIME —� <br /> AGRICULTURE WELL <br /> INTENDED LISA � OTHER WELL PIT$/SUS MPS <br /> TYPE OF WELL ROBLEM AREA CONS TIRUCTION SPECIFICATIONS <br /> U Industrial pOpen Bottom -�.. <br /> C7 Oomaatic/Pr}Wte ar'teca 04, of WON Excavation t <br /> J0 Gravel Pack ❑ Tref Via. of Well Caring r <br /> I'1 Public n Other � 1< Y Pegs o Casing d PV[ gpftirrutbns <br /> r n Delta Depth f Grput $bat f_ <br /> i f Irr+yrlk�n{, <br />` Re r a►i Rolle, Ap�` Depth i . -rararn Type Of Grout r� PN;�� <br /> Sumac Seal Enuallyd by <br /> o mp H.P <br /> Wap Destruction D we Slats Work Dvne <br /> arrester SbaEin sial (t}}o 'l <br /> Depth Fill rtarlei Ipw 60'1 <br /> TYPE OF SEPTIC WOR IVEW INST LATIQ�N I t REP AD <br /> IIESTRUCTIQN I I INC sr01K ora rmittsf,if pubkic rl�vver is V <br /> InataHation will serve: Residents Co relalavailable n feet.I <br /> Number of Im sr <br /> ng urlits: Nu bar be � <br /> Character of sa to a depth a feaC ` <br /> UPTIC TANK n T Mfg - \ Wafer table depth <br /> FKG. TREATMENT PLT.O C'"' -�-�— Ivo. eampamr,ente - <br /> Diatan to sent: Well Method of OISM1 tl <br /> f nd+itlo -- � Property Line <br /> LEACHING LINE 0 No. b Length of tinea <br /> FILTER BEDC1 Distance to Hearn-: Total isnolhisite <br /> Fou properly Lina <br /> SEEPAGE PITS <br /> I II Depth Size <br /> I SUMPS ll batsne umber <br /> DISPOSAL PONDS t7 nae est: Well Found�tivrr <br /> PrCparly line <br /> 1 hsfsby certify that t haw prapared thio a <br /> rubs and mQuletioru of the San J t>'P6=lcn and that the work—Willi be dohs in acrwdarrt a with San J <br /> Hoeyre owner a licensed 4win Local H"Ith District. oe4uin county O►dinances,state lewd, ane 1 <br /> agent's signature artlflas Lite(vlkowinpr "i.ty►twY ff�t in tete <br /> cmpby any irvaon g ouch manner n to become subject to workman's P+Kotntsnce of the work for which thle pwnvt 1s <br /> ea►tlfira the fosorylrra;"1 eerENy that M qre Derformsrtee of the work tot eompenration laws of Callfornia."Conte �s+�. i shad not <br /> tion II"of.California." o which this jermit Is Issued,I ohsq actors a Sub o sub contracting slQrylure <br /> The @Dpk"I riw.e ra` w aM 'n'aOy persoru tlubisat to Wo <br /> - <br /> rprrlfsd k►aP+ct>oro. Camplote drawing on recuse olds. <br /> S ipr+a4 C r fr� <br /> 0+^ Title:be ' <br /> dF <br /> FOR DEPA'R'rMEHT Ul sE ONLY <br /> Af - atkon Accepted by ' !7 <br /> trout Impassion by s- f�Ips <br /> Dasa r Area t <br /> Final Inspection b Dew <br /> 1lddttlorssi Coerrrnanta; y <br /> e ❑ Bth 444701 O Lodi X7071 <br /> Appilcant Ratum se O Manteca 873 710+1 Q Tracy <br /> Capt" E <br /> to: frvkonr wdW hsaah Pwtrtitt*Serylpea 1'001 a <br /> _ Nu.Itott n►w.r P.O. ISI,�, ate., CA s=i <br /> FO DUg AMOtIkT t1f1tWPTED �, 4 <br /> - A K ItsC[IVEQ all DATE IiRlrtll'M0. <br /> - _ <br /> �V /"�"W I r.. 7 .._ <br /> i <br />