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APPI KATION F011 PEWIT ..''
<br /> SAN JOAQUIN LOCAL HEALTH 0ISTPICT'
<br /> 1801 f. FIAZE:.TCJN AVE., STOCKTON, r_.
<br /> TNlephnne (20914&9 5781
<br /> PERMIT r_ d"IRES 1 YEAR FRE)M11 DATE IS4,IJ6O
<br /> ICcmplele In Trpl'aab l
<br /> i.(fJYr on R MMR nnt.l,in t le 'an Ieeq LoL.T H'ah`,C sl" Inr a 5 't n CO <t u I t)II th0 work I enllrditic,r 10 TM a II[aY v\ 7 a •14 l%JII ��,°�{.�'
<br /> +ad,. cant vnln Sar..1 mnukA L.. I Ord 111 !n 51J to,aerrage o,No ,R6 t. w.tU...nP:,nd the Note ...d Negate 1,n:of I,e San
<br /> Jcb 461rass _[_[1) al�n'7 1*l _ _1Z�,\ rin, _K„ +�SiPTA
<br /> ,3.&
<br /> } /s pG �T Cr rte' A 6 K_t A
<br /> O+•nei InnVe `! _ _�^ 1><1 s 4AA.w _.!/�'� F J a✓_ S�(Tt�"11T �J._ hon t Z J �b? It,
<br /> TYPE OF KELL)1'JMP NEN WELL C; WELL REPLAC,MENT ❑ DEST tUCCION I
<br /> PUMP INSTALLATION U - SYSTTVV REPAIR 11 OTHER rJ
<br /> INSTANCE 10 NEAREST: SEPTIC TANK FEWIiP LINES DISPOSAL Flt _„ IRO L'”
<br /> FOUNDATTr J __ AURIC +LTUNE WELL (•THEE W51,1_
<br /> INTENDED USE .`TYPE OF t LL "ROBJ&I AREA CONSTRUCTICf SPECIFICATIONS
<br /> E7 trz_'nH - CI Open UORrnn Ll Mlntece. DM.of Well E.c lvalion __ Ow.of Well Cas,oq
<br /> C1 Donxslir/Pn,ale L!11'.tl P,xk O Traty IVPs pl Cnsin0_______ Speci!icatiuna
<br /> 1'1"T: ❑Other fl D Ota LMpth of Grad Seal TYpa of Gram
<br /> 1!.hi gargn _.AITI Depth I I Ea.NNn 51,1111.Seal I.Ti"lad In,
<br /> Repea,'Nork butt Ll Type el Pomp _ __ I I•, __5bta"Jb k Dane._._ sell
<br /> %Yen Deetructia•1 CI 190 D'Aenel" _.____ "al-on FMie"al 1100 50'1 d
<br /> - Dylh_ __ F'.e, M,drial;Below Ell'1 .__ _ __._ __— _ •.
<br /> TYPE OF S(PTIC%NILLKRUN N N STALLATIOR 1I! 1 ANI/AUDI IIDN V Cslt TIDN I IN.s.pbc ayat0n palm Nen it V00,
<br /> wwcr a •. w
<br /> - ava'bbl.within 20]Ieol l Yr 1
<br /> `�Lummmclal 70thr:. IS Yn,_:a
<br /> 1nitYa:rM v.J terra. flnider\ce_ Y— ___ +:1
<br /> !Jumbci of Innlw Nr1iB: Nu, ber PI bedroomUs
<br /> Chau NN, I sQ to a depth rf 3'ser � �/ / "..p ki__ __--Wader table*PH
<br /> SEFTIC TANK. O Tvpe/Mfo __ CaRac iY Na-Comps tmenn 1 V1
<br /> PKG. TREATMENT PLL❑ —�_ ��_- —_—_ Method of Disposal Y�
<br /> Dlstznce to nearest_ Wall __ Fob.datlnn,_._ PropenY.nn {�- �t kr 13 dz5 P44�lat i
<br /> a
<br /> LEACHING LINE P"No.6 L ngih of F,1, .7 1 I.ZT'� 'lp t)Ipl IonNlh/ is ._/— V • . a4v ��r Vit
<br /> EILI ER PED t7 Distance I nee es[ woo, __ o1, d1Ucn P1up cY t ne '� (, 3}'
<br /> a y I tl�c +N
<br /> -FEPAGE PITS I I booth S _ _ N mbar 'rTd'd� 9 pert"s ,f�yg
<br /> 9GMPS " LI"Oiasance to earesC NNI _ Foandlnuh ___ Poperty Un• ��y'�d�j�A�jf+4 >'+,q'
<br /> to t �,uhilpY
<br /> JIS_=05AL PIirJDS 1 f� ! �. �rkey�TX,dky
<br /> ! 1 nereb)( rtify iM,1 heL W<pereo INN applkuien n d IN 1 e woA A.11 Lr done h accordance wi h Su J again cru Y`-'1 nonce. uta laws,.a d � -' �fN) +,�liyA
<br /> Mss and agvlelwm ofd San Joaquan Encal Hcallh
<br /> Nina owr»r u
<br /> ad .Na
<br /> emao eget 1 t.lgneture ced111es Ihb t M Ano I cert fy Ihet In Ina Po fo n a pf the o k for winch 11 a"o4t n I nll of N t r t�J(LA 3 1J M JY
<br /> wept•y any person kr s n to,ne(a1 m become sublarl wo kmefl a co ranwl on 4iyn,of..Allam a 'Conveetne.Mtru
<br /> r ng of'U4 o er nq vgnam e
<br /> kcn ynY`i /leis s!f 4Y4
<br /> .mfrs IM lo!uw•Anq- 1 en IY Ihe[m Fe taodor enc M v 4 fv wn Ih q:rmlt la W shall rmploY Iwrsona a„bpa to.1kmen'a corry»nu
<br /> tion 11 of G Born.•• t
<br /> TN,upalr. t rtwcl:.nN all r/aN,+k/ad! <pect\},n./r.o I!aIa A�awlnq on crane
<br /> S,pnoe J(_? LL—.1� . <.GG _ Title: _ _ Date
<br /> Y OR ARTMtPKSE ONLY /
<br /> ArInkAhoM AccI,TT d by <�Z _ _ Dat, ,rte //♦2 ea_(�'�
<br /> AI or u n I—po'hon by DwoF;nnl 1 p..cdcn
<br /> lo, •y! / Data
<br /> Addnkxv
<br /> IID S1k Ott-b-a51 1 3G,312 I Ke t u f323]104 T be R FU`i
<br /> Ap>i I,l P,ncra en oprs lo: Env mr.me'tal I.141m FBrmIVSt"' tel leol lliiio, Ake, P.O. Roz 2WJ. SIM., CA 95201
<br /> AMOUNT OUT
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<br /> NVO OI'�u"5-�(� _LiMf'
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<br /> ;,.} elfr�LTMsIei �3
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<br /> y�yy,)• 'yb Jt, t• fit �,af F++ t ) 1.y
<br /> d .i'P0 S•.b4,}i fz� Jx �1 s2^dt '� 'u
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