Laserfiche WebLink
APPLICATION FO ' -RMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTCN AVE., STOCKTON, CA <br /> Telephone (209) 466.6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) cribed <br /> _ <br /> 4 <br /> l to <br /> t amd1of <br /> Application a hrwahy mr de to the San Joiscruen Local Health Dtsirkt for w rNo. 1882 Iwcwel pump sand the Rules and RepulalKtrM of M S alaaQt+ln <br /> --ie m corntrow ce wHh Sen.)uarlurn(;minty Ordnance No 549 for sawsps <br /> Local Heats,[Mtr.tt <br /> ;j` 1 H�r lj- �_�_ Cayt'�fr-Y--- Lot Sue_ PM <br /> Job Addrese _--- -��- _ <br /> ==s <br /> �s� <br /> Ph. ��- +'--- <br /> Owner's Name Address -Al) <br /> y c. <br /> Adaress. License No. <br /> Contractta< _�r"z- <br /> TYPE Of ytlELIJPUMP NEW WELL I l WELL REPLACEMENT [; DESTRUCTION Ll <br /> - - SYSTEM REPAIR I! <br /> OTHER O <br /> ---1 - PUMP INSTALLATION D r <br /> DISTANCE TO NEAREST: SEPTIC TANK — SEWER LINES -- <br /> DISPOSAL FLD.` — PROP. LINE <br /> --� _ _ AGRICULTURE WELL _ OTHER WELL PtTSJSUMPS _ *-Irw <br /> INTIIfEOE UO SE TYPE Of WEII PROBLEM AREA CONSTRUCTION SPECIFICATIONS - <br /> _ Dia. of WeN Casing _ <br /> Bottom ( � Manteca Dia. o[Well Ercavatton ,. <br /> 9-- Specifications w <br /> U DpttteetrcfPrwate 1 ) Gravel Pack I I Tracy Type of Casing T __-.- --- ---- <br /> 11 hlbNc 1 nrhtr I Delta Japth of firMa Seal Yt„of Grout <br /> ---- ''. <br /> 1 t Mtgatton Apjwox, Depth I ' Eastern Surface Seal Installed bir_ -- <br /> Repair,Wors Done ' Type of Pump ---- _ _ H.P. -_. --__---- State Work Done <br /> 1 <br /> WM Oaetructron I I Well D.ameter -.--- Sesl,np Metenal(top 50'1 <br /> nenthFiner Material 18sfow 50'1 <br /> YPL OF SEPTIC WOFIK N(W _r <br /> INSTAIIATIONREPAIRrADD111t1N I OLSTRUCTION I I available <br /> osepttt M '�lled of public sewer Is <br /> stl � � [ <br /> kferallatton will serve Res1,Aer,ce come"*"gal her-_ --.— <br /> Nurnfw o1 Mrr�O uft ---` Nu 4101 of badroortts - rA <br /> Water table depth-______- <br /> - Character of sod to a death of J teen f-nlLp��---------- <br /> SEPTIC TANK Typarlrltq 1" — - K _-_ Cspacihr.- - Na. Comparmr^ts -- <br /> Method ofO <br /> PKO. Tt1EATMENT M T I I f <br /> Dietser"So"a~. Wealrty--SQ�_. Foundation��,_- Proper" Litre--,j!-6S <br /> ---77��_fr _` <br /> LEACHWO LINE No.S LtItt4Nt of flee —.R'v� F--- T[itM lergth/tMn,1L1�" - — <br /> FILTER SE.O V OlsHned is/taerM! Wall foundation l�---._. Property Line <br /> SEEPAG4 MTS i i Dsplh _�-_Sul, _ NumMr ------_------ _ - <br /> SUMPS I Datance to rwhp: Welt ._ .-_ Fosrr,dauttn PtoWnv Lh-w---_�_ <br /> DISPOS AL PONDS <br /> f hareltlr cwtAy that I haw pinna 00 t"applK.atton and That IM""k .r r Iw rr„rW a,accordance Math Sen-10--um County orrf,nancee• elate laws. and <br /> nA/e and reO,rls!ons rf the%art joetvirn Loral Health Dr31rt.4 <br /> Hanes owner ar rcensed a8em's s,pnature cerfAns the(oat w nn "1 candy that,n ttw perta"vic"of the work for vAtkh this pwrnil a astoed. I the"not <br /> arwploy any person n such manner h to become sub,ec+10 K Aft'lln's co-4wnutK+n laws of Caklartra-Contractor's hiring or sub^onwictwv o"fure <br /> eerttr Itte roaryrfry y I c err 1y that,n ff+e I erfo►m4rKe of Ir,e was Id whrcr+H perm,a,bxlsd.I shah efrtpby peltrone subtact to workman•►eompansa- <br /> ,tion,ewe of Calrlorn.a <br /> T/r atnt>tit:anf rMust <.ar fd 0" rwgr. ed wwwhena f�n[+krta Ma:,nq on re,/elrs�a sKN�r <br /> Tette r#3�s'lL_ ata. <br /> ._._.__- <br /> ♦,1 %1�OEPARTMINT USE UNLY y t"I <br /> ApeAcahen Acrea•eQ for /�- � Dole <br /> Date .� <br /> 104a C•out Inspe[HOn hie ___ . ._ DO. [flat InM+ttton by��_- '�— -- <br /> f ; so altsersl .27 ',[x. liar. K761r1str [+I1 <br /> Apat+cMt Return M r K+s to IwKnnme•tal lceetth f•errwtr3ervr'es RM E HarMton A.a., P O Bos 2o0Y, Stk. CA 9°'.x201 •�(7\,11[�Y <br /> i11 T _--• -,, •�MUNT 111kf•TTEO tri 1 �arCIWID 9Y DATE ►ISM,/ NO <br /> ` aMrh�y P 1 [ASI/ 11 <br /> ra <br />