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APPI;CATION FOR PERMIT <br /> SAN .10AQUIN LOCAL HEALTH DISTRICT <br /> 1601 t:. HAZEL ON AVE., STOCKTON, CA <br /> T shone 1209) 466.6781 <br /> PERMIT EXPIRES 1_YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Application is hereby made•o the San.Intq,,n' 1:, IIV'"'C I 11 till a permit to construct anal Install the WUk herald desc•'tied Th' ,s <br /> made in comphance Wth San Joe icm Caurry Ord••1, Nn Nn rv1P for W..vtgo or No.1862 for well'punp and the Roles;,lid papuo:ons rt r San Jp.anp nm•+ <br /> /�' Inz.�GcC17 <br /> Local Health DisIrKL !1T <br /> ,/ p l <br /> Job Address j//�.0 JIu r! ��? - - GN .5 .w/ Lot Si <br /> Ow e,'s Name 1•.�iQ6LG�'. -4�FrBi!yd5 /4CAitdrass 1�r►',�d AAAA ir• _/jVA46V_4l- Phenc <br /> Contractor's Name lekeyi> G 1 Lc4'r:2> L,cen � <br /> se No. -54-4 1,a- .._ _---- — Phony <br /> � •t'3',Z-1!. _ <br /> TVPE OF WELL/PUMP NEW WFLI WELL REPLACEMENT C DESTPUC WN i <br /> PUMP INSTALLATION SYSTEM REPAIR OTHER L. <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES __ _— DISPOSAL FLD.__— PROP. UNE _•F� <br /> FOUNDATION AGRICULTURE WELL —____OTHER WELL____._.. PITS SUMPS <br /> INTENDED USE TYPE OF WELL PrrOSLEM..REA CONSTRUCTION SPECIFICATIONS_ Q <br /> —'— — . Q <br /> : IndusldW -' Open Bottom Manteca Dia. of Well Excavation ____—___ Dia. o'Well Lacing <br /> Domestic,Private _ Gravel Pack Tra. 1 Type of Casing__.___..—_--- Spe,.d'catwns <br /> : Public - Other Delta Depth of Grout Seal __—___ Type of Grout <br /> litigation _Approk. Depth Ea[.tarn Surface Seal Installed hy.__—_---- -- —-- -- <br /> Repair Work Done Type of Pump _. _ H P _ ____--- State Work Done ----. --- <br /> Well Destruction Well Diameter Sealing Material 1100 501 _ --- <br /> Depth _ Filler Material(Below 501 — <br /> A' -._. --------- -- - -- -- - <br /> TYPE OF SEPTIC WORK: NEW INSTALLION pEPAIR�ADDITION 1. DESTRUCTION (Nosbh c system <br /> y tem or In feet i <br /> ted d public sewer,s <br /> ava <br /> Installation will seNe: Residence✓' Commercial _ Other <br /> Number o1 living units: - J-_ Number of bodrooms 7/_ - <br /> Character of rso8 In a drodh of 3 feet. CA r}r - _-_ 1� .__ _- Water table depth - <br /> / Mid ! Capacity- /Lh7_— No. Compartmenis .jT_ <br /> SEPTIC TANK F� Type e� -Ft-G- <br /> PKG. TREATMENT PLT Method nt Dispncal <br /> Oatmcn to " •'1st Won _ Foundation <br /> �Q y PrnpOrty Linn .7-tV" <br /> M1 lrnoh oTotal length <br /> LEACHING LINE No }sze_/ <br /> FILTER BED Dddanrr 1,, Wel 6211 Foundation PropertyBLL.ti .y2 <br /> - - <br /> Line /4v.- <br /> - ' Number- �_ <br /> SEEPAGE PITS v Depth -_e;W r Syr .��i �r - _ - <br /> e Pm r III& <br /> SUMPS Oirenrn to nr:n,,.,. Wrno v FounO»uur..,�/Ir Com__ pa N line <br /> DISPOSAL PONDS <br /> 1 hereby a,ndV that I have prepa,ed the.t pphr I. ,cid•.`,t Ilio wink will be <br /> done in accordance with San J03gU'n Oom'v ordinnnn•s stare lows. and <br /> rulers and tegulahont Of the San Jnnpu'n Lu,11 10•.0111 L"11.1 t ty.nn,l rvsuod, 1•.hall n•. <br /> Hume owns,or I'.:ensed agents s,gr':nur1 I q' -'I car.,.y Ih»I in the dprmanc,l nl toll work for which r' <br /> Homey any, rton.n sri_-d a manner as to nn,.nm.•m�!'q•:t m wnrkin»n's rpmpentallpn laws o1 Cdbbmla"ContracMts hnrnn•pr suo V:npaeUM suyeat✓•• <br /> ceploy Any <br /> brow mp "I n+rtdy th»r n do• f. ...1t u....v...k for which Ilia cermn IS'ssued.I shall employ persons of nct m workman's crmpensa <br /> v., .. <br /> uon laws of CaMn',, " <br /> The aopkcanf must 'All�to'a�n��n'�w u•n �• l ".'• �.�""^ rlrawmq on re trial <br /> Signed x <br /> ,� � X15--� D 7:/�-Pi <br /> 1 ON UE PARTMENT USE ONLY <br /> !1;•pL,arnn prnPh•-0 hV Lh. .4 <br /> soa"nspeu'on hr �1-t\tty� ..�4. ♦a AI�Y.....u..� . <br /> y:_o,Grnut IneMCLnn !-.. `\�p) . . <br /> andmo•+ L s ... R'1 ]1139 <br /> M )rally &TS h"RS <br /> S .rF STRt t..9 Jr ' OW <br /> • :.. .. ..., :".._. .:..... o•, 14,, E Nu:nitnr Pon P 0 0•:r 2009. Stt . L:. �. �' <br />