|
V.t�l
<br /> ,e
<br /> AP.PFtl., � 11 PERMIT
<br /> SAN JOAO � r"..7?MEALTH DISTRICT
<br /> 1601 E.-HA$F �. $TOCKTON. CA
<br /> 6781
<br /> I.FmROM DATE ISSUED
<br /> PERMIT E%�;f, _-
<br /> -- r}'tin=ry•,�SH�yv�,t�piicate) _ '
<br /> .AppgpMion b hon by made ro the San Joadusr Local tryn r(-X-lve fa A t,I,x tnxt arta/pr krtaa sed work/larsh-daaerilI This i1d1['ad-a 1
<br /> r ode In CdnWla vAn San JoaWEl CwrdY Ohl"T"I"NI ' NFCn•+yp^'s llij for WN/MM and the-Usta aria rAid,!r of Ow San JMT+in
<br /> Local Health Disiftt.
<br /> a,
<br /> Job AddmaL !M1` ,)• av_nc,!_ _ ka .S.tvi_:•�'� i-n,Lot Son PM—
<br /> Contractx :_�C�-n. _.Add,ess Q. : 4 _Licenseffo/C,1i ; Phone
<br /> TYPE OF WELL/PUMP: NEW WELL � sl tf3ENT DESTRUCTION O O
<br /> -- --- PUMP INSTALLATION �.i�',w�o,,I,rrc+ ^�}'UFf''A•R f OTHER C1
<br /> _DISTANCE TO NEAREST_: SEPTIC TANK 31s f#sL'@' n DISPOSAL FILO.__ PROP. LINE
<br /> FOUNDATION ___ Af kii.i-ryYlj�y {p _ OTHER WELL____ PITMPS/SUS _
<br /> INTENDED USE TYPE OF WELL PROBLEM 1;h,,ik ea I ION gPECIFICATIONS
<br /> G Inoustrial r'OpW- Bottomrtljq'{x'E+„kll!„'hcavaticn Dia.of WON Casi v
<br /> "I Domeapc/Pi Nate C. Gravd Pack Tre ', G.Xp•.t1f c•'+h'ng ________ SpacNludorr
<br /> Public - Other Delia Type of Grout
<br /> F, Irrigation _. _AJprna. D1p1h East 1 ��S^sl:! talbd by s _.
<br /> Repair Work Done iK 7yCe of Pump •.• , 1'I•' s♦a s¢ •: --_ SHB Work Oona 1� -e”-
<br /> Well Destm[tMn C Wall Diameter __ ._ l to Rr,� a al l .. ._.—__._ r •.
<br /> Depen _ 1 •'., ly,:,,5u'I /
<br /> TYPE OF SEPTIC WORK: NEW INSTALLATION Hf 7 `111 TRUCTION)i (No septic system pemntlad If Mbhc saww 1.
<br /> Wallable Within•lap 1Mt.i
<br /> Installation will xrvo: Pesidr sre__- Comme•nal
<br /> Number of kvinp units: _. _ Nuatber of bed. �.
<br /> Cberacto of soil to a dept))c! I feet _ -Water table depth_-_-__—
<br /> SEPTI_TANK T,,.1Mlg _ _ '! • _ No.Comwritanb _
<br /> PKG. TREATMENT PLT.:. Molhod of Diaposal
<br /> Onilknb to Memoir '.Y• __ Promie,Line
<br /> LEACHIN13 LINE--- - No. 6 Length of snvs .+ Total lengthIsla!
<br /> FILTER BED t Divem o to nearest N+'i" .j ;4•F��) ____ Prop"Line__
<br /> SEEPAGE PITS Depth _- ------ _ NUrnber,
<br /> SUMPS Dislana•c nearest. Property Une
<br /> ttt S a
<br /> DISPOSAL PONOS .;1 I
<br /> I hereby cendV that I haus;-apelel ihn applrcatmn dt,I n fhrtib{syiu wl3.r ��•i a.:co.eArice with SAm Joagmn CanttY ordinances,ttata Wes,and
<br /> ep Local Hearth U•sn.• t}�,
<br /> rules nod• ulr lien of lag$ns grialu
<br /> Noma owner m licensed agent's agnelun. CMdiea the rxio}7 dG 1ti ij,Li. of Cont of IM work for,which this Bewb o hared.I MeB)sol
<br /> umploV any parson in such manner as to uscoma sublets n w ✓b'a Tei;rh i.la.vs of CMKorraa."Contractor's eking r wRcannaetkp aigMWla
<br /> cMNkn the foeowinp "I candy incl In IM padarm.mc•of it, ,�'-}7�1i% ,?q^,Ih_go:^�•.+c issuud.1 ship amp",WmoM Wblect to wprkmpli a eompmfP
<br /> tion buys of Calitn• i....
<br /> The oopl cant('Usl Cas for all rsguoed olsfan:tw•.s. C..M I I' nJ1y M • �I..
<br /> Slgrrod X Date: ._—_
<br /> FaINyS}�•f�s'Tr`ijht9tH`F,':.F. O NLY
<br /> Appi¢auon Accepted by -S,J.'�iP ::1, l fi,
<br /> A t ,
<br /> Pit or Grout InsptrCign by ____ ___ .. O ) r.,"' , a„wl�l'.swntun by r �L`�,y.fi�_— DoH
<br /> Addnlonai Comments'. _.-
<br /> Stk .1653781 :' Lodi AW3621 ..�.. Mm n ht.j ��ty"�'//a`r)s •i v X8786
<br /> ApthCant- Relurn all copies to:FOVi trut n u He.dtr Pa '!;;.� 11{6tNaA+Rd r•m Ave.,P.0, Bos 20W. Stk.,CA BSM!
<br /> 1H�E0 AMDUNT DUE Y ANDIlr RIM1 �i� y+,R1Y� s RrG[NCD BY PATE PERMIT ND.
<br /> ' t��:„e.•[v . ���_--t � /
<br />
|