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1✓ APPLICATION FOR PERMIT
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8
<br /> 1601 E. HAZELTON AVE., STOCKTON, CA
<br /> Telephone 12091 466.8781
<br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED
<br /> (Complete in Triplicate)
<br /> APP,ical,nn is hereby made to the San Joaquin Local Health Moo,,for a Perrino to cnmtrYGt arpA/or,mlad the work hereat Aaacr4vdl TM appecetPar w
<br /> made in compfan:u with San Joaquin County Ordinance No.549 for sewage or Nu 1 M1 for~N/Ini nlp and the RWes Nn4 Rauoudiorw W the San joespe i
<br /> Local Health District. (j (
<br /> Job A00 -Ir-)
<br /> resm �- -?�-- -`' _J� _-..—._ City fJ' ff�a Lot Sin /l ►M __
<br /> Owoen's Nameqq(y,f� (.///A7 Address _/L7eYJ a 1y�rr[r--err Phone
<br /> Contractor __�/ S f'„JS vJr _Lrcenss No. 90_) 2F I'kR1F�6�-fs�
<br /> TYPE OF WELL,PUMP NFW WLLL : - WELL REPLACEMENT DESTRUCTION .I
<br /> PUMP INSTALLATION 1 ; SYSTEM REPAIR l I OTHER ❑
<br /> DISTANCE TO NEAREST SEPTIC TANK SEWER LINES __-.__-_ DISPOSAL FLO.— PROP. LINE _
<br /> FOUNDATION AGRIrULTURF WELL OTHIRWFLI PITS/SUM►S —
<br /> INTENDED USE TYPE CF WFLI PRORI f AREA CONSTRUCTION SPFCIFICAIIO4S
<br /> Industrial i Open Bolton, . Malneca W of WON Fes Aaron ._ OM of Wall raanq
<br /> DorrvalrclPpyle Gtaval Pack I.: Tracy Type W CawW.. -- _ Specarra'"e 'eC/
<br /> Pubh[ : Odw 1 !Della Depth M Orwl Sial .._...,..�.....,.� Type to Oran
<br /> InglahP, Alxxos Orgill, Eaalwn Smlace 9'eal Inufasetd M
<br /> Repan Work Done Type of Pump _ - 11 P - _ - Slate Wak tdw _---__
<br /> Welt Destruction Welt O,arneln - SeAI•rg1 Mabr,al,nap '01
<br /> Depth -__ filter Material IB»klw 5O'1
<br /> ,YPE OF SEPTIC WORK NtWINSIAIIATION , llfl'Alfl A11111111H1 DISf11tKININ, II*, per ad p,eirc aaweew
<br /> ,/ awWrM w.n,v,}TIO hit 1 C
<br /> Installation will"me Resdencri .. Conatvrcw1'11, nine,
<br /> Number of Iwep units Nun,Mn of hodfootm1a Apbr.
<br /> ar
<br /> Chactw of sal to a depth of 1 Inlet _. .I-7 e?.K.a� - - - Waver table dWh
<br /> SEPTIC TANK I Type'Mlq - _ - _ Cg,unv No, cowe rrlplRF
<br /> PKG TREATMENT PLT Ny~aDfteciffr
<br /> Dntance to moo" Wes ir«.ndnle«, property Late
<br /> tFACHING LINE No a Lwwh of kllea _ total lenuthowe-
<br /> FILTER BED I Distance to nwareet Won Fnmellnn _. plops I,Lyle_
<br /> SEEPAGE PITS v Depth s�T_ _Sue (4rf N•.xMw — - - _
<br /> SUMPS Dnlance to neatest Well/(6 [, / ra,Male«, SC ' -
<br /> - _- PlePanY Uv--� -- -
<br /> DISPOSAL PONOS
<br /> I hereby canny that I have prepared this appdcalgn and that Ilii work veal tw&'. e,a.conlence Mtn San Joag,.a,tourer u.Mu,cn. sub law, aM
<br /> rugs aM repalatens of the San Joegan Local Health D.klm,
<br /> Horne owner or I"nsed agent's apnat"M Cirdlf s the f"No off ,ren,fy net in IM pnr/nrmH,ee of 1M wok for eiheh"ne Fannie n ward, 1 MM not
<br /> M1pby any penman in such manner as to nKdxre,s,rtryMl h,wnrkne'1 a comMnaatr 4w of California, Conoacla's hexp or Not,carnacoott wrao M
<br /> cemhesthe/olbwxp l cemly Orf m iM pMmmano nl the work dor worth Ida M•ml lea,bc.ee.I Wx annlnr Irreory Whlact leo waamr,a con.ppetua
<br /> ton Nes of Cahlorn,a"
<br /> The applicant mutt call for NI weed nspechan Cnml,lele 1114.109 On nevenw ILM
<br /> `_ p 1
<br /> S.ynetlK _.. T,Ue �iC'vC'S - -'--- "--- Deb: —y_� /—
<br /> FOR DEPARTMENT USE ONLY
<br /> ApN.cston Accepted In, � �� i. "94-C�—__.—_._._ _ Date - A._..L _.._.
<br /> PK nf a GreMmpa[rOn M �. 1 1..... ': fling L�.-��a--11 Fna,Inspection br-j_!ep• / /a- 'C.d'L c! perec� ~7-
<br /> AeAPonel Corntvnb
<br /> Set Mel. 31 Loo, 3691511 Mantes R317104 f: Thar [156185
<br /> Applicant Return alt copies to Fnv«onmenal Health Pmmo'Sen,ces feet F. Harmon Aire. P O Boa 2". Stk.,CA 95101 �
<br /> 'ev'
<br /> NFO fff AMOUNT out AMOUNT RFMirtfO t�5n T ef[GYE09v DAT[ PIP"( NO
<br /> pt.
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