Laserfiche WebLink
..r <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466.6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Apphcetion is hereby made to the San.lnngwn Local Health Dartrrct for a permit to CnMUrKt and/or n4taa the ewwe hoo"m destrrbed Thin ppMcaboo w <br /> made in complrance with San Joaquin County Ordinance No.b4 for aewage or No. 1861 lot wrllf/pump and the Rulme and RequpaonA of the Sat,Amnia <br /> Local Health Districi. <br /> Job Address _L L') Gs' ��/�-- r' ,_ _ CNY 4�!;"�=Lo/fYr�� !✓�� <br /> / l <br /> Owner's Namel� �(yy1 r ltIff, Address �./_U�!_� _q J VP <br /> _ <br /> Cun(raCIQ +�� a�vNr lal:l hell�.V'r �(/�/ 1�P ��r LKrnte Nn 31Uv VZ phfH <br /> TYPE OF WELL/PUMP. NfW WELL WELL REPLACEMENT OtSTRVCTfON i <br /> PUMP INSTAI LATION SYSTEM REPAIR i OTnfER I <br /> DISTANCE TO NEAREST SEPTIC TArrr SEWER L►NEs - DIiiKKAL FkD Poor LMst <br /> FOUNDATIUfI AGAICULTUHI WELL 07HOR WtllA _r rsdAAMS O <br /> ?- INTENDED USE TYPF OF WI I l PROBLEM AREA CONSTRUCTION SPICY1CATKOM <br /> i: Industrial Open Rntlnm MpMdeu Die pf 111fo/ M V#A Carver <br /> 1 Domestic/Private Gravel Par► Tracy Typo of Cnft__-_ >Rpadfsafiens <br /> I Public Otttcr Deka Dipfh at GroW Sorel ---_-..- TWO of GK4.0 �N <br /> litigation __ Appwo■ Depth Eastern S111frPe Syr(kwidit/by-- ---- _-_ _ _ <br /> Repair Work Dore Typo of Pump H Is --- _ Sulu WMk Dawe- .--- - -Well Desfrucllot iWell Dwrieter Seawtg Matanal Itop 5wl -.----•-__ . -._ -- <br /> Depth __-- FrtIW Matwial IBakm 5C1 <br /> TYPE OF SEPTIC WORK NEW INSTALLATION , REPAIN ADDITION L*STftUCT0h <br /> - i <br /> f>•Oawl atrwerw ps"wMsd a we.ic trrwse w <br /> / aveadi fa MtMwe�w bow r <br /> Installation will serve� Resdence E f.onwrtercia' _ _ Olhar_- - -. <br /> Number of living units .`_- Numtw+r of hedroorm <br /> Character of soil to a th til a feet s� � +1 <br /> dsP ./-7.t-a��.�-frast --- Wars sNwr MlyiMr �i► s\\ ; <br /> SEPTIC TANK I ' Type/Mfg Cwredv NO CewprEwowss _ �) <br /> PKG. TREATMENT PLT.1 yyw,4 al DSM <br /> Dwierwe io rwirm-bi W[�elll ltwnteucwa �wti Low <br /> LEACHING LINE - - If/ No 8 ler ph r.f lwih _ J _ --- T yin <br /> FILTER BED Dr►Urwe v,rewrest IANM of 'Q s FelruOrsrrrl 1 as <br /> hnwvv Lw <br /> SEEPAGE PITS------ 1.1/'Depth N S _ Sue �? � Nteallw <br /> SUMPS Owtaraa it)n wresl Wwa <br /> f�r�^•.. iowrlaarow .._Jit' r Itiwent Le. <br /> UISPOSAL PONDS 1 I <br /> I hereby certify that I have pwepwwl inm olipbr arrow.aril Itvl the weft trrrli be dprss w ICt'resdstKe MiW SM,JO&O.el COWVWV e•4asspW0%,ayes seee% asse d <br /> rules end reyul bone of the San JtwtuN I o of Hoolth Iwsuit i <br /> Hwne owner or licansed agent's twyrwthirw r amlow ilio lttwtavwgp 'I cYMMr 1hm n fey preprrtaenifvf of OW Mas eat Mwtae 046 ae.•wa•eiroad.f~siM <br /> employ any ptenion in such manner ss to I"onwr suhlect hr wtw►Wren's twrhpeeinannn bM 04 CaaMtres,,Cohost t•r's KVW46 ar atI►siiMrsrKtaier tsprM/e <br /> cerNfi as the feyowing "I certify that ar OM p oftomvitiwe of the WLVL tut Meeh th.a p wwot as swans,I MtM appo"p wubft aisaswts to 0.00% n r t irwrewwe <br /> tion 1rive of California•' <br /> The applicant rnutow lot MI rwF~lospw.coons Complete d+awwV an rwrw We <br /> iJ <br /> Signed 7l_�X14-'1 s�a�.lar. a\ 1i`f '" i �L� Twir �.L.,�� <br /> iOR DEPARThIE�T USE ONLY <br /> �j r <br /> Application Accepted by -- -/T�� --- D.-! _ Ales <br /> Pit a Grout Inap»ctrort by ._ "L%1'V __ Date :�(�J. lRnst Www bon by <br /> Additional Comments _ I f <br /> Ste 4M-4781 LSM 239 W I 1 1 Menu 823 7101 C1 Tsai y 63&41M —----t,----- ---- <br /> Applicant Return all opus to EnvworinMWU1 Health Poo v t/64mv es 1101 E. Hgafwn Ave., P.O.Rau JOW Sok..CA SMI <br /> tFEE AMOUNT DUE AMOUNT 11EAMITED CASH AECCNED 9Y OATIE } rEIIWT hrD <br /> if <br /> 1•is <br />