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T Ft f 4 E rh H H _ F: I- Ch Ch r•1 C_ 1--1 F' 0 <br /> .2 - 90 FR I +t :$ COM F R -r �."T R , I tJ 4 P-..=. •.1* . <br /> ` APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH 01$TRIC'T" <br /> 1501 e. f'lA2:E,TON AVE., STOCKTON, CA <br /> Teleohone (209) 466-6781 <br /> PERMIT EXPIRES 1 YEAR FROM GATE ISSUED <br /> (Complete in Triplicated <br /> Appl:cotion it h4,-44V made to the San Joauuin Local Multh 04triet for x permit to conntrum and/or irn,,taf1 the work herein doacribod.TMs appllcalleA is ` <br /> modip in cornouunce with San Joaquin County Ordinance No.544 for t41b'49e or No 18.6.2 for woploump and tr'o Autos ant!Regulations of Itis Seri Joaquin <br /> I.oces Muatth 04ttJ-1 <br /> rlct. <br /> Joa Auaross y�e•— co <br /> ownor s Nart:e Il J..( AdCrest r ---- Rhone ' <br /> G✓lrlttir 14/ .I� ' ir—'/L.... _ ZACICless r (,►�CC'15C No./ <br /> TYPE OF WELOPLIVP- _— NEW WELL © WELL REPLACEMENT C CESTRU,: <br /> Pt;MP INSTAli t.A nON Q SYSTEM RVA!A Q OThER ED <br /> DISTANCE TO NEAREST ShPTtC TANK — SEWER !:NES DISPOSAL FLD•._.,._._ PROP, LING <br /> A:MIC'JLTUaf WELL OTHER WWI. �PITs4SUMPS o� <br /> iV7Err:�EO tJSE TYPE OF yvELL PRCIILVAAnEA CONSYfiUCTIQN SPEC1FICATICNS ~` r <br /> !Heusi.l►h C7 cpcn Bottom a Montag i Die. of Wca Excavation _ - Did. of wait Casing <br /> l.! Oa:rastlr;a,:ya!e C Gruel P9,'k 0 Ttscy "�Yia of Casing _-- Specifications <br /> i' Public f1 other r'1 001t4 Oeath of Ctrout Seal ; Type or Grout <br /> i i,:,VAt40 —App on Ocoth ! I eastam Sarface$our Inttallud by <br /> Raaan Work 0orw L; TYP+t of Purno M•P Stato Work Dona <br /> W.11 ouatrtxtion C Wall D'tLmotar q a __• Sae11;14 Mate0101 (top 601 <br /> Depth 116,61'_ _ rMai Material ("ow 3.01 'f►t"t t►► <br /> TVPfi Of SEPTIC 'YORK NEW INSTAt_=.4'7t^N REPAIR,AOOITi0N ; I DE57RUCTIOh I I INo aoptle avalomi pormlttust H publiC gewor r <br /> available within 200 feet.) s <br /> 1-100 <br /> Inattoathoa will s4rw: Aovdcrica CommarciaiOther <br /> Numl;I f Of tivhng units: Number of b- to MA <br /> Character of god tO a dbpl of 3 ipMt�; y�~ t aster table seoth <br /> SEPTIC TANK " Type,kmg Capacity No. Compar"Ments, <br /> PKG TREATMENT Pt `Ci , Mothod of C;,.oat)t <br /> olvan�e,to rtoorest; Waf! foundation ( ^, Propbrty Una, <br /> Lf?ACMiNG LINE No. Length of unpz Total Iensthlalre f <br /> FILTER BED C) 0is;3nce to rearestt cif� ..!�Ioundatlon Property line <br /> SEEPAr.0 PITS 'JQacn -. Sire Numbot <br /> SUMPS I oictoncs to ntart st. Wall �. Pourtdatton . Ptopam tine <br /> DISPOSAL POND$ '' L. <br /> I hetobY C4RIfy that I have preparrsd alis 60PIiGAtlon and that the work wilt 04 done In aeCOrdance with San Joaquin t oursty ordinances, slate taws, enq <br /> ruses and toputat+orta of tree $yn Joaquin Lone( Health Oi that. <br /> Horne awnar*f UC4nsod Agent's aignmu:•e cenit!aa the tenowingt -I ealrfy that In the p0motmanee of the work for which thio permit is sewed, I shall note <br /> 6000vamoy b6y OVS01 M such manAw as to 5 ar5O subioot to workman's cor»genstitton laws Of Cnlifomis." Contrec:or s hiring at sub•cantracung siynatur <br /> cert:=.ea'rte fot!bwing; "'colth that in Ma po+-formoncb of the work for v,S:Ch((till po✓nvt is ltsued,1•►leaf erT010V persons oubf40 to wOrtu'ttan't COmponsa•. � <br /> of Califprma." ; <br /> The applsca h7r�Iiea � .pec 3M1e. Cam ' rawir� cn e� ILC l:dQ. /5-gnod xTIr!n: ._fCY` f este; fr <br /> .�K R DEPARTMENT U5 CNI-Y <br /> ApplicatlaA ACC4plae by ,,,,� Dot. <br /> Area <br /> Pit Of Gfout Inappi•IiOA by ...�_- -- Oats Final tnrpoction by.� Date 23 0 <br /> Addition*, Cornttwntx: c`�f� /r �x act << A IS <br /> C $tk 4%-GMI O 1" 30•XZI J Manteca) 6=41104 0 racy ,43543M <br /> Applicant jAstum all caplet to: Elhvirorr*tonial *leant, Pern-A/ServiCes 16Ut fE, Wesel►ort Ave., P,A. Sox 2000, Stir., CA 35201 f f <br /> pre AMpIJNT>3U£ AMJLiNS R6MITTE0 �•1 R 1 } I <br /> INFO CASH I R[CCfvtO'11Y DATC PERMIT-NO, <br /> tH 13.24 ilury ::M qt ' <br /> aK u•7a . ( (7'r <br />