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AVIII inAl Mrs 1.4111 1=t it M1 i � <br /> MAN 40At7U1N LOCAL H4ALTH DIRTRICT <br /> IdO1 E HA41ELTON AVE. , 61 OCKTON CA <br /> Tal vione 12091 4m 87a <br /> PERMIT BXPIFIBA 1 Y9dR_FROM 0AT4 FBsU9d <br /> ICornplcllo in TrIphostal <br /> ' Applimoore is twaW rude to the San Joaquin Loral Hesf01 Dearta far s Pie- to emmun ammo,kwO dw we, ij -,m eaaeAbad 116 appli6aion Y <br /> 's made In Aompftmm vreu San Joaquin County Ordinance No MY for srwage as fj& IE52.ar weeiourrrp and the Renta NW Rtqulalketr of dw San jomp In <br /> kW.4 CatOffh O'VrW <br /> .fab Address 1448 N E1 Dorado Street City Stockton Lot 51ze 120' X 120' <br /> Owner.Name Wicklana_Oil Co. Addm,1755 Cttall.eng way, Sacramento Pry(916) 921-1106 <br /> ContratierWeatern Geo jBng nears Address 1386 E. Bmmr St•, ,�ce�a",6 513957 Pham (916) 662-454 <br /> TYPE OF WELW PUMP NEW WELL 0 WELL REPLACEMENT ❑ DESTRUCTION a <br /> PUw1P INSTALLATION ❑ SYSTEM REPAIR Cl OTHER in mit or WBU 'fid w <br /> DISTANCE TO NEAREST SEPTIC TANK WA SEWER LINES 50' DISPOSAL FLQ � PROP LINE21 <br /> �— FOUNDATION St AGRICULTURE WELL kA OTHER WELL PITSESUMPS_W <br /> INTENDED USE TYPE OF WELe PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> lendustrialMxitor ❑Open Baumn CI Manteca Oka of Well Excavation, a„ Do of Well Catelnp ey ' <br /> Q OAneuecfPrieata 9)Gravel Pack Li Tracy Type of Caaknp &" i>Slt,anh 40 Spaciflutktra "<^ <br /> M� ❑Public n ottw ftl Delta Depth of Grout Seal 45 r Type of amut »t mit <br /> rr �$ <br /> m Imes I <br /> I <br /> F ...' Approx. Depth t 1 Fsstam Surface Seed Installed by � �ta <br /> Rep*Work Dona 0 Type of Pump HP State Wont DOM t ; <br /> ,Wee#DWeWsdon ❑ Wall Dmmtelr Seattnp Material(top SWI <br /> Depth Filler Vaterial IBekaw 50 <br /> TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIRIADDITION I 1 DESTRUCTION I 1 (No*optic system permitted If publkc,Haar b <br /> avallable within 300 test I I $� <br /> 'talrrW'erre wih*ave Rasedenca— Carrnerctai— Other ' <br /> .etmber of Inmp urvu Number of bedrooms <br /> eGlt"GW of toil to a depth of 3 foot Water table depth i <br /> SEPTIC TANK 0 Type/16119 Capacity NO Coen)atanonts <br /> PKG TREATMENT PLT 0 Method of Disposal <br /> Qeatance to nearest Well Fouttdateon Pralarty Lasa ' <br /> LEACHING LINE 0 No &Largth of lines Total brtgfh/abs <br /> FILTER BED ❑ Dotance to nearest Well _ Foundation _ Ptopeny Lim <br /> SEEPAGE PITS I I Depth Size Number <br /> SUMPS L] Otstance to nearest Waft Fomdatton Property Leve <br /> DISPOSAL PONDS Q <br /> I tearoby cwWy that I have prepared gho application end that the work wilt be done an accordauxx vwth San Jo*puin county wdmanc a slaw ImM and p <br /> rpfos and regulation of the San Joaquw Local Health Distract <br /> Home owner or Ncaresad apes'*signature earWees the tollwmrtp i candy flat in dee ptulormame of tits work for whrah this permit Is itsued I shall rm <br /> eneptoy sty pwKm In each manner as to beconee aYbfeC1 w workman s cooWaftaboo laws of Cakf num ContraOp Ws hekrp or sub-000h m tlrkp tipnsat m`.--' <br /> cert{ m IIIc fa&m*W '1*wdfy tlnet in the pertorrtmme of the work for which then paaWl is isxted I sttali errQ1oy Imsotts srdroct to workman's compenza <br /> Non lava of Caktorr"" 4 <br /> The applicant must ,a r an 4 s s o bee drawing on reverse side } <br /> x <br /> Title PteBident; (CZ7 #513857) Dalt 10/5/89SihWgrnwd ; <br /> R ENT USE ONLY <br /> � I <br /> Apom Accepted by Date Arora 1 <br /> i <br /> Pit or Gmut inapae 4on by _ Date FmA Inspection by_ Data <br /> f <br /> Addkkmu i Cocnmwtte <br /> f t 460-Ml t7 Lodi 341$63621 ❑Mentetce 823-7104 O Tracy 83SAM <br /> lght.dmnt.Return 00 copses to EteveratireMttW1 Health Perm!/Somm 16D1 E Hazeitan Ave P O Box 2110,4 S1k CA 96201 <br /> � I <br /> tFEEmF0 WOUNT DUE AMOUNT REMITTED H RECENEO 6y DATE PERMIT MO <br /> tiueasv erekerS q y Cmc- 1? .1/ -Z a r <br /> ta,>st <br /> FMIS <br /> M � �.R f i.�a�a� <br /> . TICNOF THE_0RIG___ z, <br />