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i <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone 12091 188-8781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> wM SanbJwwM Cw.0sequin LOrdMw�No.6K 1or l wVa w Ne.te621w Awa//W^O a a ftwet RWw MC a deeYrbw.d M San JeIN <br /> 4 <br /> lad Elden Detrin- <br /> .we Add. ���� —m c.Car .JGaA cRY '!.'J. LM sw Ir) PM <br /> i� <br /> awwra NUI4 _FC1 G!.rl-+w_ Aabaw ;4 6 Plar <br /> CMMectw <br /> $'I" r Aaerafa 00 LLOV <br /> OE WELL/FW►: NEW WELL ❑ WELL REPLACEMENT 17 OFSTRUCT10N ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR CI OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL P10.__MOP. LME <br /> FOUNDATION AGRICULTURE WELL _ OTHER WELL HTS/SUMPS _ <br /> INTENDED USE TYPE OF WELL MOSLEM AREA CONSTRUCTION 5►ECIFICATIOAIS <br /> ❑y�pyaply ❑plan 6w ( Mwlwca Di.at—wee Eacawearl_ DY.OF Well CA&V <br /> ❑Darllwtb/P14aw ❑Gn.r Pack ❑Tr r ae d Cswwq— Spaa ftd <br /> n Peek n Dow fl OaIN Depth d Gnus Sar Tpa d Groin <br /> i I I MIpaw -ApPaa.Oaplh 1 19801401 Surdwa Seal Irwaaad A - <br /> RFpW WaA Oar ❑ Too of PwPo H.P. stale WPi Uaw <br /> Wee Oeaeucftn ❑ WA 010mawr $84181111 I' r IMP V) �a` <br /> Daps Few Moved 164bw WI _1� <br /> TYPE OF SEPTIC WORK: NEW WSTALLATIpI 1 I REPAMIADGITION DFSTAUCTION I t INe awe M.rarwn parnarwE•p..w'a wnw Y 1J <br /> a..EaeN e+mn 200 taw.I <br /> r YHeMNbR wi aww: RCatatlwcW_ Dow `\[` <br /> y Plt ,bw of kh aeac 1_ MaI10ar d eawaenu�— <br /> CNancwr M adl e a ea-P4h d S waL <!--o i,�p-(fir. Wwr Iris depth <br /> V <br /> SEPTIC TANK Tape/Mt/ ��1_ .enc rgliA Cw bm 1Y 6. 3..Q- Nr.Carrrdwawwea <br /> � <br /> PKG.TREATMENT PLT.❑ �o} // 1 opw" �d '/ <br /> ii Dl�nca w naal.w: Wy1 441 ;,- r y_CL_ .I1Y <br /> �$ LEACHING LRE d AI>a Lwi11h dam - Ta l b-rh,.t7 o <br /> FILTER/EJ C Drt.b.IN, I Do - FaR,� A Mae."Lna .A <br /> SEEPAGE I" I I D.e+ San - IA 60 <br /> SUMPS Ll Drrlw a rwwaaf Wr FweeaRwn ►IGPM ty Law <br /> wuosAL Paas ❑ <br /> 1 Ila)Me F-to,am l heed arapawe MIDI adowsea n and am*4woA M ea aarw in aaaaln�arM San JaaMel mnaY ar6nancw ataw alae.Mtl <br /> nY ane wp"M of h see AEa.Pw1 Lead"ago Ditrbt. <br /> 11pnr parr w ae.W a6w1Ee ayrrAee aa.da4a Mr Pd6awMF 1 aaraYF h11e er partemlMEae d h wI��art b e�/adh ele purr)Y laMdde.I allea np1 <br /> a 100 sew aaw+M Md nower w b Iramlr Mead w wwblaaa awn wlwtlae rwa of Calaol d&-..y.��r a IIiNE w MdCOIVa[ella.41aI1n <br /> Oaltelw h faao.rY�7 aeretE eul ti M pwlMwrrlce d er wM b r✓aN eIa prow Y Irne,1 flV anon Pvaare Me.n b wrbrrl'a oe.pww <br /> den Yew of Celtwe►' <br /> TM appacew need CA/ as CwepLdw dre+Yy e,el.ww". <br /> Iylar It TIaK �1.✓a'.t r Oa1a: 7 ` TS <br /> AI E DAILY <br /> AppldaeaR AaaaaAIa aY _ Oda <br /> Pa w GMA ahem IF Daae Pied eepaeaerl <br /> ???yrrr AdI111161r CaleeM� <br /> R. O SIE anew O Le! 3W-W O offs M?w ❑Tww/ 068! <br /> .o AMkW*•RruR/aa/AId W OIMaIerwler llaaah Pw"ettSwrte,NM F Nwaaen Aw..P.O.Iaa 3W Sri,CA MM <br /> AMOUNT DIN AMOUNT fthfff D RECTwD M A FeAaeT ND. <br /> aro <br /> a»nwP - d <br /> M Mw <br />