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'�K _�, } T^ :�':,t 4 - c. .. r t� y�^+:�•aair i.:, e1` • <br /> i G • UO 'k <br /> y <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEAL ri DISTRICT <br /> 1601 E. HAZELTONN AVE., STOCKTON, CA <br /> Tt-. phone (209) 466-Ml <br /> c PERMNF EXPIRES I YEAR FROM DATE ISSUED •` <br /> ICOmpiet6 in Ttipli ate) <br /> Appli adon ti N,,.,y meda to the Seri Joaquin Local Has"Distriri for a permit to mntruct and/m ieta6 the work finest desc:ioed. The application J <br /> merle in co•npGencs with San Joaouin County Ordinance No.50.4 for sewage w No.1062 for w Upstmp and the Runts and R.qulancoa of the San Jollesen <br /> Lotal Hec'th District. <br /> i Job Addrass _LT^—1—\/�i-a.a�AS—LTL— �./Citt Z! 1 Lot Size_— _ PM <br /> ° txNarraAddress <br /> Ca Latta a(g. —Address <br /> License uL _Ftarie <br /> Ced <br /> f L GF WELUPUMP: NEW W WELL REPLACEMEi4,p�+ DESTRUCTION ❑ <br /> 2 — ^. EPTIPUMP INSTAL JUT Nr L--) SYSTEM REPAIR CJ" - OTHVP <br /> DISTANCE 11 NEAREST: SC'TANK J;IJG SEWER LINES-' __ DISPOSAL FLD.� ROP.LINE _ <br /> _ FOUNDATION AGRICULTURE WELL OTHER WELL PRS/SUMPS _ <br /> INTENDED USE �Tr-PE OF WELL ' PROBLEM AREA CONSTRUCTION SPECIFIC <br /> r-: al �n ❑Mantes Dia.of Wes Esravat j�� _ Dia.of WaspM1 <br /> Ts`Domastic/Private GraM Pack ❑Tracy Type of Casing_//'_._f__ Speci6catioru <br /> 0 Pcblic ❑Other ❑ Doke Depth of Grout Seel .._5!�_ Typa of Grout W <br /> L:Initiation __A:%yox. Papih )(fastam Surface Seal Installed by a49&fr - r, <br /> Repair Wwk Done ❑ 1 ype o"Pump _— H P State Work.Done <br /> Wee De.^1Clcn ❑ Weil Demeter _ Seahrp Na^.'vial(top 5D'1 <br /> Depth Fidler Materiel 1116ow W) <br /> TYPE OF SEPTIC:W04TK: NEW INSTALLATION❑ REPAIR/ADDITION i7 DESTRUCTION O (No Wfic syatam Mrmitted H public sewer is <br /> - _ waeabk whfJn 200 fiNL) - <br /> Irmailatrr�i v+lI senra. Residence_ Cwnrnercul__ Offer <br /> Nunlher c"F,arg un tz. Number of Indrooma____ <br /> ChafB"M of sae to a depth of 3 feet —Wants table depth_— t <br /> SEPTIC:TAN'; ❑ Type/Mfg — Capacity_ No. CampartrpMns ,. <br /> ` <br /> PKG.TPEATMENT PLT.7 Vmhod of Disposal _ <br /> y Q Orstanco to nearest Wall Foundation__ Property Linn_ <br /> a `a LEACHING LINE ❑ No.6 Lettgfh of lines Total length/alae_. <br /> R RED C Distann to nemeat Weil Foundation Proper'Y Line -,' '• <br /> SEEPAGE PITS ❑ Depth __--Sim _ NumMr__ <br /> i 0 SUMPS C Dfsennee to nearest: WWI Foundation____ Pro a ry.Lim <br /> DISPOSAL PONDS -`-.J <br /> 'hereby rwtlfy EFat I h4,10 PreFwad fiK oyp!icatbrand that+he work will be dome in ac cl,rKe witrn San Jospuin county ordkwwea,state mere, <br /> rules and mgu]&Wm of this Sen 'napuin Lnz;HeNth Oiatricl <br /> Home mvnor or licensed DwInt'a sego tum certifies,rhe fo#owuV:"I certfly that in that performam,e of this wort few we'ch this Perri is'leued,I shall nos <br /> oft,pk e'r1 PafaOrt In weh yin pea,eft to Lade"suhfect to vioduro ri s W mparization Law of Gfdt,TiY"r wrecte(a 11Wq of IWbCtMlledllg algNtum <br /> rar•.ifies the eoliow ng;"I cordfy stat in the performance of the wor!:for ivri this pemVit is naved.I shalt employ persons sulfer to wod•man's cwnpertea- <br /> t . ton sof <br /> Tlio vmxvqt9Q for rxpections. Comrevplete clawing on side. _ <br /> /d <br /> Stg,ro.^.�.�:nJ+_!Z`' L �i�/�- Titb:_ Do": <br /> FOR DEPARTMENT USE ONLY rY <br /> Application Accunmd by 4 — Date 7'ya Arae p <br /> 'A w Grout tru^nan VY .�.J-Y-_ ''. ! 'JVDOlate��a` 'goal'nnpsctWt by_-/fL/]pC��l a+�r�.�— Den <br /> Additlone! <br /> Q_tk 4E6-M! ❑ Lod) 3t,;-=1 / ❑Manton 823.7101 ❑Treq, 8354 B6 <br /> Applilant-Return aR c,-pW fee 6erkronmanta{FIvlth Perrolt/Servlc"1001 E.Hetaeon Are.,P.O.Bots 2008,Sv%., CA zJW <br /> FEEAK JNT OVE \MK;iT REMITTED UBH REC£NeO BY DAT[9 PERMIT W!. <br /> INFO /j� <br /> Tr <br /> a <br /> :�_• y ,.,; ,.: eY-.... —:re�r�a:�_'•,+a�siflel�IRaYY <br />