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1. <br /> e <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` 1801 E. HAZELTON AVE, STOCKTON, CA <br /> ' TOuir ofle(209) 488-Ml <br /> :PERMIT EXPIRES 1 YEAR FROM DAv= i3SUED <br /> -- (Complero in Tripicate) <br /> ApNimlpn Y/rerlY n,ado m Or San Jo.4J,laAl/bafth[Menicl for a pwrrat a cpgr,rd snd/w ittR6 dr work Mora,daavbe0.Tho appfuom r <br /> uri an COr1e F c Wldt San Joeprin CwWWy Orli+ No.5491w aeeepe or No. 18R Iw v aWU Pimp ono the Rwn and Mpinxn 01 on San JoaPil <br /> Loom Haatl,Ofaukt. <br /> .100 AArhr 17?584 F /yl�A�-- CRY 5772 l Lila Sue--PM <br /> O..l.Nrr1WAA0, /��=41V &2AEl— Ad&. Phar <br /> Contractor L: � s License Na Pltwte <br /> TWE OF WELL/PUMP: NEW WELL O WELL REPLACEMENT O DESTRucnoN O <br /> PUMP INSTALLATIONS' as i"PI1 REP/1JI) O (.j <br /> DISTANCE TO 0011,4411111. SEPTIC TANK __. lK1A [1{IZf D1{POML HD._MW.LM <br /> FOUNDATION A,;RICULTURE WELL _ OTHER WELL PRE/SUMPS _ <br /> INTENDED USE TWE OF VYELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> O 4d6WW O Opm Bo so O 111 r D'w,of VVA ErgRwtia, D'a of WaE CahV <br /> �OarrWaalk/MBesr O Grs,a Pas O Tney Type of Calwq BP CW gdolr <br /> h"c J Dow 0000 Depth of Grout Sal Ty"M GMA__ <br /> C a 9er6m —Approa.Depth O FaRern Salam Sed hrta4o by <br /> R.Psh V..xE Oar Cn TYPO Of Pwrip M.P._Z SWM Werk D. FULL OEFELT7�l6 f1 <br /> W.4 Datrucnon C. Well O+mwhr SOOV MaerYl Imp W) 14!a V-/A.' Sr,9W— MEW <br /> Depth Fier M 11 III k SITZ .J.YL? ^ <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION Cl RFPARUADOITION O DESTRUCTION O IN,..ptfc ayerartr M pu0fc sewer .T[ <br /> 9vai0le witt in 200 fall <br /> YrtaYOon s,V earva: Readerrw_ Comrraa-_ Oprt �Y <br /> Number IN VmV wYr:_ NwMv of OrJrooma <br /> Chraaer of soil to•depth of O hat:_ _—_ Water t"depth <br /> SEPTIC TANK 0 TW*,MWa —_. Capetlp. __ No.CongwtmnW <br /> f `K0. TREATMENT PLT.C Method o1 DupoaY <br /> Oww"to mala(: Wal____ FOWA@don Property Law_. <br /> LEACHING LINE^ C7 No.E LRVIh of Betts Tort Mnpth/ <br /> RLTER SED O Drtertta co rWaara.t: WN FaYlitlm Property Lina <br /> R _ <br /> P SAGE PRE i.'. Depth Srs Number <br /> f <br /> SUMPS G V�me m n.ueet: WOE. Foundation.___ Property Law <br /> DISPOSAL PONDS Ci <br /> I hsmbv ORIF,der I have ptapered da appbostim and that p`e v o k wore M torr W accordance wth San Jofd cwmty mllc ce.,Waa Tawas <br /> Wu1w ane reStastwrr d Ur SL"JmWA Loral Killed,Oeancl <br /> IIOmr ower at hawwed a9mWil wgnaYwii ORt i the toaoneV:"I cwecy tilt N er pe-forrrwxR d be '\lo. ch this perms a Yrrsd.1 SW rot <br /> anpb, Ta.:any person W w.ch Wwrwr a m I,eoolrr 1u0ero ma m wwalw,'v mtp W"of GMrtw <br /> ccum.".. ,r .c:o.h"V w sub conoac*.g aple <br /> pan Ism o bM'waV:'l0erdl/dW W d,a Dallor,,,er,m w Ne wort Iw+mach dWr o.mar tt WxrM.1 Ysla r , a.:�r a.uteKt m wwhmr,'o cpmperwe- <br /> on lase a Caalomas.' <br /> The appbc:wd a cOwtt.ermConpBets dnw+V m. DM: <br /> �m�er/w <br /> Sgrrd K UY1yJ <br /> X�._ _CLL <br /> / DEPA ENT USE: : <br /> AppYmom ALvptW by �dr�._ Dew Ary <br /> PR w Gran begCvan W -- Dae . FI 4xpeluorr M <br /> 1 Addmon.t Cornrurea. _ <br /> �f C SO, 4115"1 O Los Ywml ❑Marlwm 37106 O Ttacy 8%4n5 <br /> ADPL w Rnwr,A copies EY FaRiRw,wil/heEh MrM/SaMima 14DI E.Haalmn Ave..P.O.Sm lIW.SIL.CA 9=1 <br /> A§101r:e DUE AWWf M11TRD � KCOVED SY OAiE eFMEi'fq. <br /> z — <br /> .M .ay., .a A <br /> a <br />