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Monson t. %W1 am At PLiCAT:0,N FOR PERMIT SAN JOA:.UIN LOCAL HEALTH DISTRICT t. 1601 E. HAZELTON AVE., STOCKTON, CA Telephone (209)46G-6781 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED t� (Complete in Triplicate) Application is ly_-reby made to the San Joaquin Loca:Health Ofstnrt for a perrrit to construct andror install the work harein deseribwd.This application is made in compliance with San Joaquin County Ordinance No.W for sewage or No.1862 for ,.tl!PurnP and the Rules and Regulations of V+San.Joaquin Local r4e3lth D:stnct. (� /� Irr L� �7 _f -�l-- -— City " C/4 Lot Size�X=�3P- PM- Job Address _.. /�_,1 /' /� Owner's Name _.J.L_(1±_� � N v- _��- } Address ty _^t Pho `(✓�- -/ 1c�_ � Adlress _k_L f��.l_-_9.! -----License No. O��-drone �L Contraclrr._" EJ TYPE 7F WEL7IPUMP: NFW WELL i WELL REPLACEMENT DESTRUCTION PUMP INSTALLATION i . SYSTEM REPAIR : ; OTHER Cl SEPTIC PROP. LINE DISTANCE TO NEAREST: SI:NN TANK=- _-_— - `- - --"---SEWER LINES DISPOSAL FLD._ -- - FOUNDATION ___ AGRICULT_'RE WELL _ OTHER WELL PITS/SUMS _ INTENDED USE - TYtE OF WELL PROBLEM AP.EA CONSTRUCTION SPECIFICATIONS Dia. of Well Casicg Industrial Open Bcttom Manteca Di...of We if Excavat on - . Trecy Type of Casing---------- Specificatiors Domestic/Private Gravel Pack Type of C cut - Public Other Delta Depth of Grcut Seal -- - Irrigatrr• .__Approx. Depth Eastern Surface Seal installed by -- --- — T of Pump _ H.P.-_ ___.--- - -------- State Work Done Heyan Work L m, Type - - -. --- L11.11 Dearuction Well D.3meier ,.._...__....._ Sealinq Material(top 501 _-- Depth-__________._._._._..._ Filler Material(Below 501 TYPE OF SEPTIC WORK: NEW INSTALLATION ✓ REIAIR:ADDITION i : DESTFIUCT.ON i.. INo septic syr-.•n la"rmnmd it public sewer is available within 200 fev,.l tit ` Installet:on .v.11 serve: Residenr>_ .-_.. Comrnrrcwl "v Other _- - W C°Ol^v"7 yr% v U- 1 ;.umber of:.n3 units' ___- J.umbcr 3f fjedrooms__.__ _- LGP�- .- -- .Ware;tat•ledepth .h of 3!Cel. .. -----.._-- -- Ct.�racter of soil to a dip' - ---- po tyLei No. Compa,.ments — SEr11C TANK ✓Type Mfy ..CG.N - L- - Ca cr - Method of Disposal T i1m PKG. TREATM.E%T PLT I r - Drs'.ance to nsvca ell /�• _ Foundation Property Line-[G— --------- - - - - - r flo. P, Length of lines .-- ._ ---- ..---- Total length/size--_--"- ------ ; LEACH NG LINE Property Line_ P r FILTFR BED Distance:o nearest tiveu_,_ "-___ Foundation - - -L -- -- Number -"-.--7- t/ DePtl• ��I - Site._ 7._ I J SEEPAGE PITS Property Line - SOUPS D.,tance to nearest �`+eu l�_�---- F..,dation"-� _-_ _ tri pISPOSSi.p0' D5 I hereby cL oou tt,_:I i.ave Prepare;the apPhca:non and that the work'N II be done,n accordance with San Joaquin courtly ordinances.state Taws,and rules and regu'a:sons of the San Jraqu•n Local Health District. Hcrne owner or licensed agent's signature ceR'(es the fotlowiny: "1 certify that m the performance of the work for which this permit is issueni.1 shall not employ any Ger»n n such m.,.ner as to become subject to wo-kn,ari s compensation i3ws of California."Cone-actor's hiring or suh contracting sigrwture t� ce'trtles the V.2rso ring-"I cer:fy:hat n the perforr*•ince or the work for which this permit is issued,I shall employ persons subject to workman's compensa- lolO tion laws o1 Czi"forn,a ol,cart r--st call!Or alt:e u'red insy.ruons. Compere drawing nn re.ere Bede. Th.aC. ,it Date: Signed x � .. - aax FOR DEPARTMENT USE ONLY ,)/ -t Dat. An :_z..on ACLCG•ro 7'� -y - / ., r. /` /6 < / •(IZir_�-+I'r°"Date ... Final Inspection bV _.-�.. ._ �J� ll�,�- -_ Dater-l-_1-'• / P,,•r pr6ut,r;',ecC c.,by b .. --__ - Aod-ln,-`Co"^ Nlaw ca 893 7'C0 Tracy 635,638`. c;f 436-3E _. V�Q 3621 P O Ro.2009. i t, fa201 Er —ritar Heath Peri+, Serv.ces tfiot E Haterton Ave., A 3pre'-. Het . _... - 'o E INNri, . x--T--RF:,EIVED By DATE PERMI•NO� E a!d:/�'. f I AV7�,• cl.C.t tED I