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y,e 'S f i � a, r✓n"�' ' <br /> K y y r f h s .'.7PLILA71r� FOR <br /> - <br /> F� S`t: JOAO + LOCAL nsrC7n <br /> 160I E. NA%ELTM FYI.. STOC C"Or.. C:: PERKIT .40. V r <br /> ' .�•'l l <br /> Tel (20) 466-0 <br /> r DATE ISSUED <br /> a . PEFVlI _10IRES 1 YEAR FRQ"l 017E ISSUED <br /> ' �t t:� (cmplete in Triplicate) <br /> � `� ' <br /> 11cation S h'&byi+lisde"to the San:Joaquin Lxal Health District for a permit to Oft. 549t arior /orsew install the work herein <br /> ascribed :rJh1s`Applitation''is'rade.in compliance with San Joaqu"n County Ordinance No. 549 far sewage or No. 1862 for re117vu�o <br /> Rulsi`}n4-gegulationi'of'the:San`Joaquin focal Hraitn District. <br /> Subdi•lision Name <br /> AM` Phony <br /> Add!r phone <br /> a� _"" � �- ����••,� 40c.eskse NOZ a_z fa <br /> L catorsfieLn�ei <br /> x WIG MENiiEtl : ❑ WELL REPLACEMENT CJ- DESTRUCTION CJ ( � <br /> PE flF. PUMP WORK w <br /> d` s <br /> STALLATIOl <br /> '+y PUMP�NTC3 SYSTLM REPAIR OTHER iJ <br /> DISPOSAL FLA. PROF. LIKE <br /> CISTANCETO`MEAREST 'SEPTIC TANK SEWER L11iE5 _ k <br /> AGRICULTJRE CELL OTHER S:cLL PITS/S'uVS �f r <br /> FODNDATIOH " <br /> INTEMDED`ilSE+ '61 TVPE 4"s YELL PROBL� EM AREA CONSTRUCT[CK SPECIFICATIO'h <br /> :; dcistrdai,, lr! ,- Open Bottom .. [�Manteca Dia. of Well Excavation <br /> r Dia_ of Well Casing <br /> a tfc( ,rate ❑Gravel Pack ❑Tracy <br /> 5.,d <br /> 5 <br /> r Ti 9 G Other ' []Delta Type of Casing r•, <br /> rs w •x•i Eastern, + ARPTox L ❑ _ Specifications r :• <br /> .aCtion�'. r3+ Depth of Grout Seal <br /> i <br /> ys to Type of fr;ut a <br /> r t <br /> a ��' Surface :al.Snstall ed by <br /> 1Ta'isr ?4ti P w li.P <br /> -State Work Donepow <br /> t <br /> a•p4 eillDiantori S:.Stil 4ng Material (top SO') <br /> t ip�Vth'S4 .yti r~,«y.1z F(llsr Material;JBelow 509 ---------^ o3S yk <br /> it ra.itted if public sewer is <br /> ;�C 1iQ<i xNEN INSTALLATION FIRJA IiION (tw septic tank or seepage P DQ <br /> available within 200 f-et.) <br /> ar111"serve f lis 1f Co�ercial Other <br /> staff Rion, - r <br /> yUnit �Nuaper,of badroors ,Lot size <br /> it to;aroepth afro feet — Water tabic dapth <br /> r - -•a`. A.a r'- -Capacity W. EDaPartalelltS' <br /> 4 <br /> [� TrRs%Mfg w <br /> PITS,`.❑ ,TyPl�Afy'"' Capacity _ Method.of.Disposal . <br /> M 6 ' Foundation Property Line` <br /> r5 OlstancerW naarest, -Nell , <br /> TAUCTIfIIi ❑,� , ,,rr:rr• - ��` <br /> �.,.:, Total length/size <br /> 1en�tl�fof lines' ; Property'Line <br /> p ttgce,tp nearpct Ne)i Foundation <br /> ACE ?tAy:�»" csize Humber <br /> Distance'to.n4arest. fell Foundation. Property Line <br /> that the work mill be.done in accordance with San Joaquin county t A <br /> ifyath+t liavesRr4p}red th/f aPplicafion and, <br /> t yak ,ynd y asrand fregulatiOns,ofithe 5an`Joaquin Local Health District. <br /> sed agentlA flpnatYrs.certifies the.following:"i =ertify that in the performance of the wok for which this <br /> id4i[i ha311noC hWloy any''persontfn.suchfoanner as to become subject to wnrkmanY caspensatian dews of California <br /> ntr3CtOr.'.;f C1nqr'ti4bLContraetinipisignature Certines•the following: "I certify that in the penfo*>nancc of the work far,which sz <br /> s sited. 1s,sf1ploy persons subject to.workman's compensation laws of Ulifnrnin. f <br /> t st 11 r 1"f Vireo inspections Complete draring n verse side. Date: / r <br /> Awl",1� DR DEPARTMElIT USE ONLY Q Stk 466-6781 <br /> � s s , Area T <br /> b Lodi --: 369-3621 <br /> «•�+ .R Date a Manteca 823-110 <br /> P 4 MGput Tnspaction`b '`�' =p <br /> k x oate p Tracy 835.6785 . <br /> i lnfxction by t� <br /> turn, la'eo i to aEn irro ental .Nealth Permit/Services 1601 E, xelton Ave., P.O. Box 2004, Stk.. C.1 95201 <br /> A sa ale ��R �PrC a �., <br /> fEE :.BASE" AMWNT? DUE ; AMOUNT REMITTED RECEIVED 8Y CJiTE q3- L PERMIT NO. <br /> 'INF p 1 <br /> a a ° <br /> 11182 500 <br /> D13 24 -REV 16/82F 1 " <br /> _ 26 <br />