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1 f,r <br /> yul <br /> spq" <br /> < APPLICATION FOR PERMIT +y <br /> SAN JOAQUIN LOCAL HEALTH UISTR:CT <br /> 1601 E. HAZELTON AVF., STOCKTON, CA <br /> Telephone (209) 466-Ml <br /> s PERMIT EXPIRES 1 YEAR FROM DATE ISSUED_ <br /> (Cornplete in Triplicate) <br /> ,4pplitatinri Is horeby media to the Sen Joaquln Local Health Markt for a Perrot to porutruct anchor I'll the work herein dasc"bad.Thi"apulkation is <br /> made ki mmoar,,,with Sen Joaquin County Ordlnartca No.648 for sewage or No.1867 for wail/pump and the Rules and Ragulatkan of the San JOWuIn <br /> t< La al Ha lth DIctrkt.//y /�•t zip�C,.��/��y./✓/y /�x J! <br /> Job Addrem -ya-f- �ija.�i�{ �,l�f�•yJit� CRY/� Lot Steel y�I .L��PM(!—r <br /> Owner's Noa _/ Address <br /> t'\ <br /> m <br /> Contractoes Name <br /> TYPE OF WELL/PU : AEW WELL ❑ WEIL P.EPLACEM Mf DESTRUCTrON t` <br /> PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER CJ '•. <br /> DISTANCE TO NEAREST: SEPTIC TANK -- SEWER LINES DISPOSAL FI.D.__—PROP.LINE <br /> FOUNDATION ___AGRICULTURE WELL _ OTHER WELL--- Pits/SUMPS = <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS y <br /> C Industrial ❑Open Bottom ❑ Manteca Dia.of Wag Excavation—' _ Dla.of Wo Celkig U) <br /> C Domestic/Private Cl Gravel Peck ❑Tracy Type of Caainp— Spec"ICado n J <br /> J Public ❑Other ❑ Delta Depth of Grout Seel Type of Grout <br /> C Imgatbn _Approx. DeWh ❑ FAstern Surface Seal Installed by <br /> Revlr Work Done C Type M Pump ____ H.P.---- State Work,Done. l <br /> rY <� <br /> Wel!Daetruc[ion O Wa71 Dlemater ,_—_ Seeing MarorV.i(top�0'1 <br /> i, Depth Filler Material iBelow 60.1 rT'- I I '• <br /> TYPE OF SEPTIC WOP.K: NEW INSTALLATION C REPAIR/ADDITION, DESTRUCTION C IAN 0.10 00 it system pomttad I aawv N ro <br /> evsitable wt in 200 feat.) <br /> Insteilation wnl serveRea dance�CoromencblOther - <br /> Number of;lying units: - Numher o1 I>ad o + <br /> J f <br /> Chereccar of sell to a depth of 7 feet:—�' — _Watilf,tew depth Y a ail rl <br /> SEPTIC TANK C :We/11fg -- 1 __.�--- CapecitY---. No.CranpartrrwRs '''''�F <br /> Method'gf Dlepoael <br /> Ya PKG.TREATMENT PLT.^ <br /> ff ..ttt,,,...... Distance to nemcst: Wall FouMetlon__�Property <br /> rY LEACHING LIIJE tip No h Length of L --Total h/slze yr <br /> .FILTER RFC LA Dlatsncn'to nenrert:� Well_�pS. 4- FounMtion�� Property L'ms <br /> SEEPAGE PITS C DoPm <br /> SUMPS 'Distil to naare.tt Well_--- Founds ion -.Property Line C <br /> mare SAL PONDS C3I �- <br /> areby rX•rtlty that I have prepared this application and ths:the work will be done in a--•frdanrn with Sad JaYquln coin oWuwrces,stats laws,and <br /> n,and npuletkuw of Cts San Joeq:dn LOCA-Health Dhplci. y <br /> Hume owner or I'ica-mod sprees signature c ani'lea the tollcwlng:"I«\nifY that III the perlorrnence v9 the work for which this perMt N issued.I they ml <br /> y^ vmplry any?amen in su.:h manner as to pace"whieet to wurk.`nen's wrepenaetion lave o; Capfeepill Contracto!s hiring or wt�e ntmcdng aigt um ' <br /> �_, crortlflM the f0towinp:-'I UNH that in the perfomunce Of the work for which this permit h Issued,I 1 employ penpns wbtacl to workman's canpenaa• i ;• <br /> ton Iowa Of Cailfomia.•' <br /> Y' ";'he atgrlieeM �.}'ep�Mr all tap I ow.Can'%" drawing on e!de. I <br /> /t-ae/�a - <br /> iHa:'b'��.r _,L��� _- Date: <br /> FOR DEPARTMENT USE ONLY <br /> Appricat:cn Accepted by Date Area — <br /> '� Date Pita'Inspection by Dec.��� <br /> Pita Grout InaPactbn by — <br /> 5 <br /> A means <br /> a-rta: ❑ Lod3E& ❑Monte" g-3-71 W. ❑-—Trialy <br /> 8354M%36�Scant <br /> -Retum all copies to: ErMlinunenaa Haelth Permh/Servk:as 1001 E. Harshen A,*.•P.O. BOX 2DO9.Stk..CA Stt201 <br /> Y <br /> tEE VNT our VNT NEk1tTTtD - Op _. NECEIVED BY GATE �eNMfYY/0. , <br /> 'B�clbb ) <br />