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<br /> i APPLICA'S�nN FOR PERMIT
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �<C1-- r �
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<br /> !-4AiE:LiC7n' AVE., STCJCKTQN, C=A `lflljt ti .
<br /> 7"el:�l]hciirt Il(191 4fiEif7A] I. 1� ;, � 17q�
<br /> PERMIT EXPIRES l YEAR FROM DATE ISSUED ti1,01",- 4t tit
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<br /> {(;rlrttpletr', !n 'T rihl:c;lt'•} �:i�_;(( 1 �l w
<br /> !tin Wnf[I, r(�
<br /> It,:'titin JnS,:u• J 51 lt4 t, rt ::r.tt.t ff. ,n+,•:!„!to l:nr5ll 410 Mid'111
<br /> r+r•in �-1lFif°' 1�l¢{h�ilif lS,nn•c
<br /> r;,,.;,',rv, t.rh:i,t„.!,ia•tv,n fnnnty U d ,-•t:.•N 1;1}r Y tin e,r Nr, 11412 Iw w,!Ilih„++1+nn,l Ir„•F{o'es a n Halsti,I I. 1q04 1fie San Jnayuir,
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<br /> rilY-•�1�!`•K[ _l�1_ F.nt SFre --- PM —_._...__ .
<br /> 17,v,,,.:• .:,„.,.,�u-ro_.+�tl.�'aT_ .EIJT"v_ Adr}r,:<� a. t,-A2__ RR�
<br /> COLA
<br /> WELL REPLACEMENT I.' DES7RUC1IOK
<br /> PUMP INSTALLATION I-) SYSTrM REPAIR I OTHER 5(McNITDGraf6 taltL
<br /> 01"ITAP1CL 70 NFLAREST: SFPTIC TANK �A ___ SEWER LINES __�A._..„.---- DISPOSAL FLD. P PRt7P. CINE gyp'
<br /> FOUNDATION "_3U _._, AGRICULTURE WELL ►J_h_.__ OTItER WELL, rA_.w P1TS15UMP5 _!J4
<br /> 4.,.11 p,;l;f:ll It;',s: ~TYPE OF WES.L r PRORt FNI AREA CONSTRUCTION SPECIFICATIONS
<br /> _ pis.of Well Casio
<br /> In<!nsinal I"1 Open Ctollom i L hlanteGal' Dia.of Well Ercavatian_—I 4 -
<br /> f]n,nesnc: P,-1?e 1-i G-avel Pack 1 i Ttac..Y TYVe of Calinpt-olk- 't---«------- Specifications
<br /> Orher Ornth of Grow Seal r_�.71.h1 7 e —. Type of of Grout�MCA,r—17F I
<br /> Apgt<pit. Depth' 1 ! Eisstern - Suft;-uo Spat Instalirut',V 1�;1r1�j.��Lf•�LL'+.f`.�.,,—__--�..»".-"---�-�..
<br /> Rofl,lo Mill, Penn• i 1 7YAe of Pump --- ._- 11.P, _ ---.-_---._.— -. Some Work pone
<br /> W01 D-1r,rrnc;", , . Well Diameter _ Sewing Material Itnp 501 _...—_.. ---------- - — ---'-`
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<br /> Depth_..,...r._____.._...,.•___W._ F'dlar Material lselow(11'1 -.�_ __.. ____.___-.-.--_---'-'—
<br /> �----�-
<br /> Iyol, 111 1;Ij'IIC W0 11K' NEW iNSTALI.AlION 1 I R(IPAIRiADOMON 1 1 DL_;IH1tCTH)N !•{Nn Sceptic sY`"not 1,arm+Ned H p+t!>♦rr.sem+ ,S
<br /> availahla wttlsn+2(10 fiwtt.l
<br /> L,c!,1!!ahr,,,w,1t serve: Residence _y Commewl,11
<br /> iJun,hr, of 6v,nq units; Nombr,r of bedrumns
<br /> Ctrtraclrrr M s,,'I to a depth of 3 feet: _... _..—.—._._... .—.. .-__.�.__.—_-.- ---»---Water table dt-nih
<br /> 51:1'71(', TANK1T 7ypeiMlg No.Compartments —
<br /> PFif;, TR!�ATfdENT PI T.1.; - Method of D;slxsal
<br /> Oistanra Iro naarest: Well Foundation PrgpenY Line
<br /> t"A('.HINf:: I INf: _..,.I I No. R L,!noth of Finest/^ Total IRngthlsize
<br /> ��—
<br /> FII 1:11 M0 I I Distance to naruest. All!ll � Fpundnl'fon--_...__._..»--;Property Line_-- ---- ,
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<br /> til I PAhF 541t; 1 ! Depth __�... S're _.."._-Y--• Nt,mhef
<br /> tillhsF": I 1 Dl tante In nnarnst: --Welt _ ___.. Fo%jndation„_„, __._._.:''Property tine
<br /> PONDS
<br /> 2 I+rrchy,.,Tidy that;have pr--fell thio allIlk. tion and Char iha wark with he Flom-in atcoedance with San Joaquin county ordinances, state laws, ani! ,
<br /> n,I,•.an,!wool at„v,s of Ihn San,Inagn.n Local Waalth Ustrr-1, `!
<br /> „•.. nr f,cansed agent's sipnnlure cotlifios the fo1!nwirsp: -I c:,'+tify that in the pe:rtot,nance fi!the work for which this permit is issued,1 shaft not
<br /> r rnp!ny.,`:Y{,•,r.:nn,�sut:h mannor as u,Barolt,o stehtncr rn wott,man's comPansatinn laws of California."Controcter's hiring or sutr contraeling signetum
<br /> ,,,•rt,l,nc t6, '„Rowing: '"I GnrtifV 1IMI B'Ill"l'mintntnnre n1 the,vnrkii,r which this pafmil is issued,I st1All employ persons subject to wnfkman's comPsn”-
<br /> r•,n law< n1 r;aL}mnia." .
<br /> yF}eall rpt all two lad rnSF,nCbons. i:ni-lsthr!e rfr�:wir:q
<br /> on r /ome 9ido-
<br /> !l:,,•,1'x; , Q!~��/a��!J 1,1 ' h 1',fi i4G (y/}j(/ pate: ♦V�
<br /> ' F fi i7FP/+RTMERT[r:E ONLY r
<br /> .YMC' O Area
<br /> Alin'„ow,,, Ar. f�. ..l.--__.,.�..._...»._..
<br /> iJ:str,� ”+. d.,.....- F1onl lrtsl,;rctLp
<br /> ,nr sy r= ._—.
<br /> .... i La1t tsih.lGl1 LS h'nntnra E23 IIfl2 i.l Igor,µ : S&V5<i
<br /> 1,„t„,n all rnp,Ati tn: Env!,:,nn,•- ,,I lfonf:h Hnle!tnn Ava, P,O. Qo,,:OMT S1k.,CA%M1
<br /> •MOUNT r:'� VIC)lltit IE1,MitYTr] CA:II 1Cf.F',IYEO AY T()A PFRMII-NP.
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