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A'vL;CFTiOY FOR PERM;T
<br /> JO-4L;!• LOCAL HEALTH DISTRICT
<br /> 1601 E. HA,ELTC4 AVE., SiOCK?Dr;, Ca
<br /> Telephone (209) 466-578, PERMIT N0.
<br /> °ERYIT EYPiRES 1 YEAR FROM D4 TE iSSi,ED TATE ISSUED L f- j
<br /> (Complete in Tripliccte)
<br /> Application is here'•v made to the San Joaquin 'Local Health District for d
<br /> described. This application is rade in compliance with San Joaquin County Ordinance No. 549 .-or sewage or
<br /> anal the Rules and Regulations of the Sar- Joaquin Local Health D,strict, P`'rinrt to construct and ew install the Werk hereto
<br /> Job Address__a�f / y 9 No. 1862 for well/pump,
<br /> Owners Name
<br /> L /' �.•lE�obdivision Nime
<br /> 37ir (.L Address
<br /> Contractor's Name -�� --/-C 4y7 Phone
<br /> License No, _
<br /> Phone
<br /> TYPE OF WELL/DUMP WORK: NEu WELLE" -
<br /> WELL PLACEMENT 0ESTR'JCIIO9
<br /> r ' PUMP INSTALLATION r-1 SYSTEM REPAIR
<br /> DISTANCE TO NEAREST: SEPTIC TANK, c L I OTHER U
<br /> SEWER L]NES DISPOSAL FLO. f.
<br /> FOUNDATION PROP.WELL - PROP• LINE V�
<br /> _ OTHER WELL PITS;S"S 1
<br /> INTENDED USE ?Y:_E OF Wr.L pn
<br /> ^OBLEN. AREA CONSTRItCTIDJI SFECiF_ ICA110tr
<br /> Industrial J Ope,i Bottom U Manteca - -_---
<br /> (J Domestic/Private Dia. of :.+.11 Excavation
<br /> Gra':;; ^ack r Tracy
<br /> Public Uta. of Well Casing
<br /> I� Other
<br /> U J Delta
<br /> Lj Irrigation APprox. CJ Eastern Type of Casing -•—
<br /> I]Cathodic Protection Depth Specifications
<br /> Geophysical Depth of Grout Seal
<br /> j]Other Type of Grnut
<br /> Repair Work DoneEJ- Surfa_e Seal Installed by
<br /> Well Destruction Well
<br /> DDiameter Pump H.p, Strce Work Done
<br /> Li --
<br /> Sealing Material (top 50')
<br /> Depth Filler Material (Below 50') - -
<br /> TYPE OF SEPTIC WORK: -NEW iNSTALLA'luN[ ; REPAJR :,PDiT1Ot 'j (No septic tank or seepage
<br /> Installation will serve: Residence pat permitted if public sewer is
<br /> _ C^mmercial Other vailabic within '00 feet.) -�
<br /> Number of living units _ Number of bedrooms --- �, /�!
<br /> Character of siil to a depth of ,i feet: Lo' sire
<br /> SEPTIC TANKT
<br /> yPe/'+f ,� r Water table depth
<br /> PY,G. TREATMENT PL:, 9 !�- -Iu- Capacity&, r Q
<br /> Type/Mfg �J�`�'G1u �
<br /> ,ff Nc. Compartments _
<br /> SEWAGE SYSTEM ""``i- �-"t J►-42�{ acitY Method of Disposal�'pi,c��7 ,
<br /> DESTRUCTION Distance :o nearest: 1<e11E Z« pond ion
<br /> ,�' �C G/ Property Line
<br /> LEACHING LINE L I No. R Length of lines -
<br /> FILTER 5EJ i ---— - Tctal length/sire
<br /> _ Dista•a: to nearest: Well
<br /> t -r -_ Foundation __ - Property Line
<br /> SEEPAGE PiTS K bepth -4t Sire 3 -
<br /> EuMFS - - - - 'lumber
<br /> L_, Distance re nearest: well L eel Foundaliun / Pr
<br /> DiSPGEAL PONDS - ! - _- gperty Line
<br /> 1 hereby nc -rEs, s tat that ' nnve ules r,,; this application ,nS that the wLoc will be done in accordance with :an Joaquin county __ �Sr
<br /> ordinances, state iseC and rules ani regulations of th!- Scn Joaquin Local Hralti: District.
<br /> Nome owner ss liceIsn a;en t s:gni;q;^ certifies the follawiny; "1 certify that in the performance of the work for which this
<br /> ^er i; is isshar', I S., it net ar.,plo, .i ., person in sbch manner as to Cecome subject to worksant compensation ;aw% of California•^
<br /> Contractor'; !iir;ny �• •,;,,_contract`ng,g;ynature rrrtifin5 ice `ollgwin
<br /> this per^.•t is issued, 1 Sndll M1)lo versos,ibiect to w0..:do's ern^.pEnsdti0nr1aw5 oftify aCaliforniDerrormance of the work fpt which
<br /> The applicant must call for all re,uir n ;n;pr.r;.•o,;., Complete drawin; on reverse side.
<br /> Signe^_ f.- :71., �. l ( Title: )
<br /> cE ptEC D , -r- —
<br /> Additior,ai ZL'•^en;s: 1 - n�•_ ••r•.a t v� ,❑ Stk. 4',(,_6781
<br /> Lad 3b9-3F
<br /> :i: or Srcv: :n-r , +nn �� � -- � 21
<br /> Ja'e tint-cr 823-7104
<br /> Final in5:%eEtu•nrD,• -- - La t^ L( ..
<br /> ;l scan: - ..:urn tit copier .p. 'E,,•,i r ! U✓ �_I :rt,I ° 3
<br /> Ave.. .0. Por T•_,OD, Stk • CA 9520,
<br /> -'-__-___._-_._--...
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<br /> U.-
<br /> 1K., � -
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