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... 4 77
<br /> APPLICATION FOR PERMIT
<br /> SAN JOAQUIN LOCA,. HEALTH DISTF ICT
<br /> 115,[)1 1 FIAZE,70N AVF.. STO(:K'10N. C.A
<br /> I1. Trl,phorie (;)091 .166 filHT
<br /> 1'FRMI1 EXPIRES 1 YEAR FROM DATE ISSt1FD
<br /> (Cnrlplchr tit 1nIiL•1 stir)
<br /> �1q.Lr.d n.u. .I•...••.r, . .r.,• •.,, . . .,'I4...,Ir! :..r•u I Inr,i 1....r•-r r.•,nn itu,t.v..! rn.n•.Ln d..-wnr♦t.err,n•ies ntA f This appin'ahnn.s
<br /> `� n,.n 1.1.. .. nl dr.... . r.. ....• r ,i ,.,.i , ry •.1'1 1 ,.r....1, .,r.'J, l:d.;!w w,.0 p.p'q:..til lhr H.rins and Hetp ddlrnns of the bN JtMq,Ln
<br /> I•.b Ad.irrsti���VV(� _ r: -�.J'�6�"�y.} !,v... ..._._ ..____ PM._..
<br /> •!wi .r s Nno,e• 1�7 D_ Q�'ess�i.. �?�JI-C IIC�tS(�W Phnnr•
<br /> hunt!rc!a LL S....•' / �:J�yi j ! �7 .r• ti• l i 2-373 Phnrr V6.6--/V
<br /> [YrE CF vFLI.TURI•P NES":IrFLL Wtt, Hl 1'l.�(:1 r.p NF UISIFII.CTION .
<br /> Yt1�
<br /> PIJh1P INSTAL[4110N SYSIE'.1 111 I'M I .A---- CTFtFR
<br /> DISTANCL TO NEAREST. SEP,IC TANK :itWtA IINF:`, DISI'rISAI. FID - FIROT' LINE _
<br /> FOUNL'ATION _ ;.Fiitr�t.ILTUHI lbf.I 0111,R Wf l l PITSijUN4PS
<br /> ` INTEN..-Fi;USE TYPE GF V,'-1L 0801!11%1 AWA CONST IMC;ION'il'1 CIF-CA!WNS _I
<br /> Indirsiral r Olhm 8oltUm \;,e.k ca Ura of 1.',•'1( Ola.of W..1 Casing
<br /> JDTr"nci Private (.ra":f"Alk 11a y Tvpr o'(.,::rn•I $pet:rLcahors - -- ---
<br /> f'nhLe Ori„•r . Dnl'a [iepth M l[rm11 Sr l -. _ Typo,rf Groul ._
<br /> I,n,Id1¢:n A;.I.n,- Orplh �. -L.>i 1in SWI ca'n 11r1.WIFUd fly
<br /> ✓
<br /> T4e•p.ur Work Done TvI,:!of Pump _.C•f.e. FI P .._ r SWIG Vinik Da"'
<br /> bVrll Des",ctrn :; Wetl Diameter ____. Srnhnr Ma•rn,',i(hop!4)
<br /> Depth -. __ F.Iler Materiel IReluw 50,; -_ _ _
<br /> I si'L OF SFI'ilC vV1:3F1K N:.V INSTAI IATION I 11L VAIF:'1DO,IION i ' 0'!.14UC11(,N OJn septic syshrrn Fw1mrtN•d d p,rhlc sewer n u
<br /> '� --------' -_ ava;bhlc within 2t1<1 feet.;
<br /> Instillation wi:l.C : Residence___ CCmm2rC.al__- O!he:
<br /> Number of I:vnng units: --. Number of balrooms
<br /> Cluracter of sod to a dept:i of 7 frrl_- _ ._. _ _. _ -. _. .. _-.. Water table
<br /> !'LPTICTANK II Typs,/MlgCapacity. No. Comp.imnents
<br /> PK;. TftEATMIENT PLT.I.i Melhod of Gaposai
<br /> Distance:o neem—sl. Well .. Founom,on P,upertv Lune
<br /> ` LEACHING ONE - _--I ! No.8 Length o1 Irrras ._.. .__- __ Total lennth/srrr.
<br /> PI TER HED I! D,:;tance;o naarest: Well _ _. .. Foundation _ _ _ Property Line
<br /> SEEPAGE PITS I I Depth _- ..---- :;ter
<br /> SUMPS I I Duta:ua to nearest: Well __-._. _. ;oundauon ... .... ProperTv Line
<br /> O:SpO$AL PONOS ;I __ 1
<br /> I oemby censfy that I hive peeparert this application and that the work-ill be done in oar oiddnco with San Joaqu,n county ordinances,state laws•and
<br /> ru:a5 acd repuiat• - r r anJoaquin;-ocal Hea.lh District.
<br /> Hunte rwner 4cenwd ape i s sip.,au.re cn'ldins 14
<br /> tullowinJ:"1 certify that in thn pnr:ovnaeco of the work(m which this peanut is issued,I shall not
<br /> e"*.!-A y any son in such. :mor as to o. u�:ea to work!nsn's compensation lawn of California."Contractor's tiring or sub eontracung signature
<br /> candies t followin "i ei tha n d m ice off v,ork Inr which this per mit,s Issund.I shall employ sons sub Act to wcrkrnan's cum
<br /> B� :Y p V Ypu'. I pUnsa
<br /> :ion law a CAI. rnia."`� / t_--�
<br /> rho ap :1ca t r� all>� 71I n lu r � or plain dra wrap /y,///�
<br /> SglI% X- -- - I�ay-�=._L��� .__ Titin: -L.-�f/----•�/'/ Da1e: �J�!_-!S!_
<br /> t`
<br /> OR DEPART HT USE ONLY
<br /> G' o
<br /> . ppticetinn accepted by Oahe CJ/`�1 Area _-
<br /> pit or Grout Inspection by -- - Date-- — F;nal Inspector by-:!L5'--ct•- - Oate�
<br /> A.:drional Comments:
<br /> Sik 466-5781 C,Lcji 369 3621 Cl Ntantece a23-7104 LJ Tracy 1335-6385
<br /> Appl�ent- Return all copios to: Fr.irnrmental HsaCh uermit'Services 1601 E. HBdellpn Ave. P.O. Hoa 2009. Stk., CA 95201 S�
<br /> C
<br /> I LE AMO11N1 DUE AMOUNT 9Ek!I77I.0 CK I HFCEIVFq 9Y DATE PEHMSIT NO.
<br /> INFO CASH
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