Laserfiche WebLink
eA <br /> t <br /> APPLICATION FOR PERMIT <br /> FL' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 3 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Temphwe t2091 466-6761 <br /> PERMIT EXPIRES T YEAR FROM DATE ISSUED <br /> (Complete in Tripl.wtel <br /> AppfkwPm Y hoshy mala so the San Jotfg.wr Locsi Heatpt District la•PerfM Io comoucl and/Ix i tall the y I*twain d w bort-TF:a OPPLcadpn"' t <br /> me'w to coftp'aanca wan San Juapeat Counfv Ordr "No.543 for sewage w No. 1862 tot vM/wmp arM ea A00%erM Regulstiotw of tnN San Jfaaq r <br /> Eoc}He,"Owtrct. <br /> Job Ad&", az�s;" ef' Rjqe lanm en-T Cnv -,-;- — Lot Sira PM <br /> Pho N 46 -8l> <br /> TYPE OF WELL/PUMP: NEW WELL D WELL REPLACEMENT D DESTRUCTION ❑ <br /> PUMP INSTALLATION REPAIR ❑ OTHEh <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _ DISPOSAL FLD._ PROP.LINE <br /> FOUNDATION _ AGRICULTURE WELL __ OTHER WELL__ PITS/SUMPS <br /> ti INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> D Ind"Inal D Opal Bottom L'Monaca Dia.of Wet Es ovation D'a.of Wet Casing <br /> ,k Don inimi wa, 0 Cravw Pack C I T,wy TYoe of Ca" Spe-ihcallorN <br /> '.'1 P. FI Other f Doha D•pth of Grout Seal Type 0 Groet__—_ <br /> I I WWI. _Ap,Roe. Depth <br /> ++��IeeIE¢ston S.fsoe Seal IMtaw W <br /> er _ <br /> RopWork Dore U Type of Pomp _!5.1 z H.P._ Z State Work Done�yOZ� p� <br /> Well Dmtrtrclioo i: Wet Dwnetef Seakg Mate-M Itop s.0"1 2!; T-U <br /> Depth _ Fito Mater.}IBelo� 5C — <br /> I TYPE OF SEPTIC WORK: NEW INSTALLATION I i REPAIR/ADDITION I I UE5TRUCTION 1 I [NO apto sotarr•pernufted 1113 bi-sower is <br /> ayaiabie wnnin 200 It.) <br /> IMta4ton w1T save: ResMara_ Cp111TIarCY1_ O:hw <br /> Numoa of It"port.:_ Nr mbw of e4droonw, _ N <br /> CIwKw of soil to a apo of 3 fest: _water labia depth <br /> SEP.'1C TANK D Type/kMg _ Capacity .— No. Con"nrtrnu <br /> PKG. 1 aEATMENT PLT.L7 Method of Disposal <br /> Diawtca to r.*~: WeiFoundation_ Property Lw <br /> t <br /> LEACHING UNE I I No.i Length of ktaa Total length/stn <br /> FILTER BED f l pgaoa to newest: Way Foundm K Property LIN <br /> SEEPAGE RTS I 1 Depth ____ Spa Nunoer <br /> SUMPS I I owtanca to 044,04E Wee_— Fartdaoo _ Property Lao <br /> DISPOSAL PONDS 11 <br /> I hauby tenet,ort 1 hen ppa d ten OPPlorhm aftd that pro w k we M oaN n accofo a In San Joaquin[wnty ufdioar .suer 6: .aM0 <br /> noes erten feg,", a of the San JoaQtMt LOW tual:h Dr ocl N <br /> horM ovaTwt a d por <br /> kwwet's oyehre wndM the hoaow+V. "1 cerat,that n ttr penorffwlca d is pa <br /> the wofli fw which this is NO -d 1 ahai <br /> /Mpogo •}(L <br /> arrploy n Whet maW N KMN WpW GENM wtt korai a conn 'J Ywa Of CAMNp ."C*our tcll hifug o w wb' VKlpg YgfelWa <br /> { cendl he foaPefag:"I coney that to ten perlomwoe of ten work for whch ten pefmt w naued,I"ampoy PafaOtw WD}ct to wofkmsn a cofepMw- <br /> ton laws of Camwt '- <br /> The app►ant_./`/-t//y/T . ConpMN&...won r r <br /> Syed X_-'^�-�- — ///!�/�� Tia' _ ZZ1 -57 Dau: <br /> FO DEPARTMENT USE ONLY <br /> AppR4fon ACCpled by au / A,�� � <br /> Pa a Croat 1.%pwc ht, Dau I"tnspecoon --i" <br /> A06terel Cwe is _ <br /> O SS 4664EXI ':Lodi YS 3621 C Menu 8237104 C Tfacy 8356385 <br /> APphnm. Rerurfr a CF4sNe W.ErNeorawKo HeaRh Pamt15ehfees 1601 U "-f.Ron A"_ P.O be.2008. SA..CA 96201 <br /> FEE AMOUNT DoT AYptP9T RAWTTW GSR RECENSD 81 DATE PIRNII MO <br /> ME0 <br /> for <br /> (nN} <br />