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L'X;!, ,,E_L!
<br /> H4-Z L T 01, .1,F. S 0u, CA
<br /> ii PERMIT NO,
<br /> PEPMIT E,VIRES I YEAR FRQ�I, !SSijEL) OATS ISSUED
<br /> A
<br /> Complete in rriolicdte)
<br /> I Appl Icat Ion i S heeeb, -�ade to' the San Joaquin ,0Cal Health District for a remit to construct ane,/or imStall the work herein
<br /> ldflCrlbed- This AP[IiOtlon 0, made in torDlianCe with Sari Joiouin County Ordinance No. 549 for Sewage or No. 1862 for wpillpuftv
<br /> and the Rule$ and Aegulatinns 0' the San Joacuin Local Health District.
<br /> Job Address.2j000s E, m6iqxre^iF -C L&Fpplctv 541)d 1 inion ane
<br /> Address
<br /> [I Ower's Name
<br /> jContractorl, Name 1111L_� 7
<br /> [Mom&UPinsZotpLicense �No, 1'7 q.2-3 Phone
<br /> 22
<br /> �TYIPE Of WELq PUMP Ww ;� NE14 WEL1 E] WELL PEPLACEMEIiT i: DESTRUCTION
<br /> PL;" i'ISTALLATION Q0 SYSTEM R£PAIR OTHERLI
<br /> • '!D[%TANtE TO NEARE,-T: S[!PTi'C AV SEWEI LIN�S OISPCSAL FLO. PROP. LINE
<br /> c:-7 6-i AGRICULTLIOZ WELL OTHER WELL PITS/SUMPS
<br /> INTENDED USE TV'C OF WELL r'1;08LVA APIA rVONS7RUCTI^N SPECIr[CATION'S
<br /> Industrial
<br /> :,�)tlocn Bottom Manteca Dia. of Well Excavation
<br /> yl
<br /> Onmestf0privato r-
<br /> (,ravel rack L Tracy DI'l. 01 WPII Casing
<br /> IFlub)ic
<br /> D
<br /> 0-her LJ Delta
<br /> -ype of Casinq
<br /> Irrigation Approx. f—jastern
<br /> ,[3 Cathodic Protection Depth 5pLciflcation5
<br /> Geophysical Nl,th of Grout Seal
<br /> Other
<br /> Tyne of C�rojjt
<br /> Surface. Seal Installed try
<br /> Repair Work Done 0 Typo n
<br /> State Work Done
<br /> Well Destruction [J Well Pia,-(,ter Scr04nq Material {t7p SO')
<br /> Depth "I— filler llatpriai (Belo, 50')
<br /> 7 —
<br /> ".TOPE or SEPTIC WORK: NEW I'iS T4 J.AT I ON [71 Q E PA I R/A DO 1 T!7l :Ant. or Sereoaqe pit ;vermittm ifc ubli -ewer I
<br /> P , s . I
<br /> available within 200 feet,)
<br /> Installation wilt "rvv: Pes idence Cor"rc i A I Other
<br /> .1
<br /> Number of livfnq units: "i Number of bedrooms
<br /> L Character of soil to a oviqh of 3 ftnt: Water table depth
<br /> EPTIC TANK
<br /> 17 rnrociv NO. Compartments
<br /> ' Y
<br /> ',.PKG. TREATMENT PLT, [�j ypej"f�
<br /> pt"d of Disposal
<br /> :rSEWAGE SYSTEM
<br /> Fli%tance to nearest: Property Line
<br /> G
<br /> DESTRUCTION Well
<br /> LEACHING LINE
<br /> Nn. length lr lines 7n 'moth/sire
<br /> ILTER BED
<br /> SEATER to nearest: dell r,)U"I Property Line
<br /> SEEPAGE P115 t
<br /> Silo
<br /> 91-Q I y I.Ine
<br /> r'sumps to neal'pSt: y1'1 I pert
<br /> t
<br /> :UISPOSAL PONDS
<br /> �.j hereby certify that y., It - e can JoaQuin cn!jnty
<br /> i 1 this AlIfflicaLinn �Iq� 1:1�1,1' 1 d i In al ordInCo. with
<br /> ordinances, -Late laws, j: cul;•; and -nc.uIations of tine ta, 'nanti 1.411,0 Dvtri(t.
<br /> Home o;,rnor or ijq-, : I 11'r.
<br /> .1tarf? certjl�p� the ."'t in ti,,p (if the wnrk for which Chi,.
<br /> Perim-it is issued, I in -un;-ct to Iiw,, of F.alilnfniA."
<br /> !n the p;F)•mancenf the wnrk rnr which
<br /> ,ili', ',qi' is calico rnia.
<br /> 111n r-.,, jr. q,j
<br /> L rid 1 301671
<br />
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