Laserfiche WebLink
APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ .1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (Complete.in Triplicate, and work herein described, This aPPlicaAiOv is <br /> permit to constliuct /or install the Wo <br /> is t 1862 for wellipump and the Rules ancl Regulations of the San JC0qUI`n <br /> is hereby made to the SWI. Joaquin Local Health Dilstrict lot a <br /> ,`­nty Ordirranoa W, 549 1 or sewage or No <br /> ,narje,n comioiance with Sar-Joe(lkrirl r <br /> Lot ot Size <br /> job Ad 's <br /> Addr.1s <br /> I-kcenSe NO.af7s� 'Ia__Phone-15 <br /> A <br /> N WELL C WELL REP', CTION 7 <br /> TYPE OF WF1L/PU.k1P1_ OTHER C-11 <br /> PUMP,INSTALLATION,D __,SYSTFM REPAIR 17 ppoP, LINE <br /> SEWER LINES DISPOSA.- FLD.---, <br /> I)ISTANC,E TO NEAR ST' SEPTiC TANK PtTS/SUMPS <br /> ............I. .....-1 _ —. -- AGRICULTURE WELL OTHERVVELL--, <br /> FOJNOATIQN ........ <br /> PROBLEIvIl.AREA CONSTRUCTtON SPECIFICATIONS <br /> INTENDED 0SF TYPE Or- WELl- Dia. of Well casing <br /> ........... Dia, of Well excavation <br /> Open bottom <br /> lnd�jsTnb� - SpecificaTiont <br /> C1 Giave� Pack U, Tracy Type of Casing—-- <br /> 1 1-1 Della Dooth of Grout SOal Type of Grout <br /> public <br /> Opier I apth Eastern SkIdace Saul Ynjjjalled by <br /> State Work Done <br /> on Appmx� 0. <br /> H F. <br /> Rel vjw� none of Pkimp <br /> Well ojarrieieo sealing Material [lop ...................... V) <br /> Filter,M1119, "Below 9 r is <br /> Depill I ESTRUCTION I potmnled 4 P)blfc will <br /> 71 lei 200 fee,.I <br /> '�fK—NEWINSTAlL�ATI-0—N-tv available W�th <br /> �J <br /> 'Iarowwill serve: Resoell�e kfCmrrerc;aj Other <br /> rtits� Number of belifoOms Wafer table-depth__ <br /> Norriner of 1�ving 11 1 <br /> ................. <br /> t 3 <br /> of soil to a dopt"� ........ No. compatimerils <br /> SEI V ................ <br /> VTIC TANK Melhod of DiSP014at <br /> KT. <br /> P (;. PLT dabon Property Une <br /> Welt Foon <br /> ............ <br /> Totailengthilsile— -1 <br /> 3 1 Prop�rty Line <br /> No. Length of lirws ,-- <br /> w1em ridation <br /> MTER 8FD j Distance to neatest ..... ....7- <br /> ............ <br /> NomI <br /> SEE P AGf PO'S Depth <br /> four�datinn <br /> Distance to neaflII -Welt .................... <br /> wilt lie done inaccordance with San JcaQu'n County ordinarlces, SIele laws, and <br /> I shad suit <br /> which jhm permit is is ed, <br /> t Hear:e awner pr licensed agtrnt'm sigfrtazurs certifies tha fallowing: "t certifythal;a) the performance of the work stgnatuta <br /> comps <br /> laws of California.,, Contraciovs t1i7ing or sob-contracting <br /> ploy porsnna subject to workman's COMIPOns5- <br /> which this permit is issued,I shall em <br /> ...................... ................ <br /> Thot 1ppInant,must cat! 1.0quirI,d <br /> jnSWtions. Compiale drawing©n reyame side, <br /> Tithe'. ----- <br /> Signed <br /> ENT USE ONLY <br /> Applicatior Accaptod Eay09T <br /> r-inel Inspection t <br /> Date <br /> A,dcrtionaj CommI0'Tracy <br /> Szk 466-6781 2 Lodi 363-3621 0 Manteca 823-7104 p.O_ Box 20M"Sik-, CA%201 <br /> I likoplicanx - A sturn all ioP*5%0', Environmental Health Perrrirt/SeTvices 1601 F Hazelton Ave- <br /> 2t �I �IAI�14 <br /> CK <br /> REMITTED RFC0VE0 By <br /> FEE .AlI DuE AMOUNT RE CASH <br /> INFO _7 <br /> H 13-A tiREV I L <br />