|
;.. - ` - ! r :.;r, ,,, ', ""} S ayl'' yw+,''w..t•7;'p
<br /> '5j a ry rM
<br /> PPLICATiON FOR-SPE M:'
<br /> SAN <STRICT e 5ya
<br /> x + . a a y 1601E NA2el TON AVE S OCKTON CA r ',qe h A , ERa'f1
<br /> f,�' h elephane (20°} 4fi6 5783 ¢ H "yyyy
<br /> 1t' ° s'� "�',�'� ' r 9
<br /> PQMIT rExPIhES 1 YEAR:FRDM DAtE ISSUrD rf 4 r'_ i
<br /> fir4r a'+ e.. mar, tr,r4 1complete)in)Tri Dlicaterr:r�x ',�a
<br /> elf fir. "P a .r.�'{ i { r "! wyt�€ .dy rt .►''iir Y:
<br /> A0R1ki at:ion +erebf'radeit0the San 'Joaquin Local;Health District fora permit'LO Canstruct'bnd o' Sta t
<br /> described j�This appliicatiod„is madr in CDMpliance with San Joaquin County Ordin nce No: 549 fa ewagefortN 1962 p 7
<br /> iLiBnd the RuleSradd;Regulatipns of the San aoaquEh Lotal sieaith District. i
<br /> i�obsAddress� 009/V:f+rl(/ A �� �' 5t:bdivts+ao�4ame � n
<br /> Owners Names i��r ar ��Address ' r
<br /> r Cantrector s;Nem2� �"�"��4i'IL�Eense No`.�r. .k"�"��`�'x`P� n
<br /> I
<br /> £5TRUCTSyt� ^ PUMP,iNSTALLAT{CN EAIR { � �Ai,OSTHER �' 9O
<br /> 15TANCE+TO NE�ARESi SEPT1CITANKtH$ xlSia SEWER L[HE5r7T5PO5AL`FLD 9ROP. l
<br /> :,
<br /> &"#F'r3 ,
<br /> FOUNpATIOM " AG RI CULTURE,WELL:, OTkER+WEIL PITS 5 P
<br /> �1NTENDEDIUSE, TYPE OF WELL PROBLEM AREA r? z CONSTRUCT1n.N'SPEC IFICAT!bkVL j
<br /> Indusrtrial,��J`:� e £,}'',7❑Open 9ott6m ❑Manteca 7 "pia of Welt Er.cavation "
<br /> q 2�� '
<br /> u Dao stic/Private °}Gravel Pack Tracy Dia Of We111Casing} „llai4 `{
<br /> P li blr'� �rc� ther U,' 1,3� is
<br /> 1� t r. -:-r❑Os ❑Delta '� :Type of,Gasing., S .,_
<br /> Appror as astern, SPecificatians
<br /> G Cathodit Prp[ection '`� # Depth i, f� Depth O Grout $ea1,�N
<br /> ❑ eophysiculi "tZ r Type of Groui
<br /> OCrer SurfaccSrea3 Cnstalled by a r
<br /> .p'hk _.c,9 nW t s „K� ,r•,r'Lir .' r�� .-rr,_k`.'�'T''a"H � 4,`•,ta teWork Donck i `+ . G.
<br /> Ae air WorkOone:❑ type of Pump # , kH P`
<br /> e! Des�ructrion ❑ Well piametlr" -
<br /> a•� ��`
<br /> MIrtr
<br /> T�EPE�Of SEPT[C WORKerm
<br /> NEI�'u1NSTALIATIDN D, RCf�iAyIR)kDD�T�[QY (No septictita,jar seePa9 vP aVailab [esvithS 20�
<br /> � � �i"�ti°�`F'�r#gY��"$ia�p*w�:d al rP �1 r���5 r, r�i.. k,•
<br /> Installation wil 41erve.Aesidencee na t"Commera
<br /> NiA n It �gOdroo {�ti���a�lotrsiz r.adNQ3AU9' �
<br /> ,Number of livin run is yWumber}of bedraomsh
<br /> _.111td;_r �� d3[_4a+' X43«, `~ �t,?i, >r Water)taa1C'
<br /> Character of soilJto a depth of 3 feet .
<br /> P t L h [a acitY No4�°Ctrnent�s {:
<br /> EPT[G�TANK at' 'r❑� :iype/Idfg, r �l R t a tr1tR
<br /> l Y u y u iCaPacity ' _ kMeEh§od of Oisppsal�
<br /> G�TREATMENf PLT [� Type/Mfg;•
<br /> Property L{ne
<br /> SEWA €SYSTEM, Distance toynearest Wellyt�Foundatlon,r � � "
<br /> r e,l'UE$TRUCTIDH `'7❑rs .i x �, a xira i e 4.� _tet_ :tiN i
<br /> t Total length/size'-," 11"l;xt* 8
<br /> LEACHINGALINE� , e No ;3 Langth of lines e ^ 1
<br /> i1LTEE�'BED {yl� uyDistanceftornearest, well t ;Foundation " v Properit /Line �i3 �
<br /> w3 .. �ry1 "� ❑
<br /> _ c,
<br /> y
<br /> ' Pr eri Line :� k«
<br /> Sip " 1 �f U "Distance to„nearest Well (�11J ^Foundation
<br /> � f tY i s:.} � + f
<br /> DkIaSPOSAI POflOS r „.' Ll+ a u �, `„_4i
<br /> i ['heretifCe;tsfj''thatihaVe'Prepared this appl ication and°that the,work will,ba dene',fn accordance w�iifi"ISafi Joinuiri�co�u`n
<br /> 1 rd4nences State,la+�s ;`and rules and reguiatfdns.of the San}'Joaquin`Lacol Health District "f*
<br /> Hare o5+iierkor licensed:agent Vsignature.,cersiniPs in' Uch`mannernas to becomecertifysubJectnEo workmans�lcomi do w7aw5 ai fCt�fi
<br /> perm!t!iis issued _[ shall not;employ any pe o
<br /> nContractor soh ing or,s'ub contracting signature certifies the Following I certify that t the performancel"of"th wali< o
<br /> this Pe"it issued i ishal l employ Person sables y to workman s co p�enSatio�n�laws�n CalAfo ?�
<br /> The apP�ic ! xcalr ff ra I—re"a ed ' sR cti 's�F1 Complet drawl n re arse sfde '�+,y
<br /> s � �v 40,
<br /> si4 4 Yt/J'iTftle.r
<br /> ,i igned .
<br /> FD D PAE;7MENT I3SE^NL Areary � .. Stk. 45 ' 78I
<br /> A{ ry-,Appiication Accepted «f
<br /> rai p - +fi r 7 s �' ,`m``, +.,Ot.r./�3..lti y?On'?r ^ Q y Oddi {' 9 2.
<br /> Additional Con.nent5 i rih t V
<br /> ,.�• r'U:22 -.3 . 11
<br /> .CL )atdr�ll_r,',.,�=fl"„"I.�" Ma taco 23 .
<br /> 2p1i or Grout [nspection sby3 �'�7rat
<br /> . 35538
<br /> {`F1na1 in SPetiton�,by�,s�rh
<br /> APR1lcant 50.ettirn all copies to 'x Envirroncental NeaTihsPermit/Services 1601 iEroyiiazeon rv0 St A
<br /> 5 FEEw BASE AP10U4T D{lE ! A�IUUNT;RE 1 T£D l3ECEiYEU OYr
<br /> •.� j�'„ NFi1 la
<br /> S�;j� v,v fi11.Sd.d
<br /> V- 22LJi
<br /> p T ji J e 4 9; f e
<br /> L +i '9h.` , 7{i :, '.is � -{�rybJ •*'�y ,6 jS¢ y,rr 7 �-3' r�A- ��' r
<br />
|