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r?". . SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> ..+;� 1601 E. IIAZELTON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> PERMIT EXPIRES 1-NEAR FROM DATE ISSUED <br /> I —__T_ J <br /> (Complete in Trii+bcatel <br /> No. +e for wwegV or No <br /> +Pd3 for well/pump ann he nines end R eulauons of the San Jona r <br /> Appl Wvon is hemM mads to the San Joaquin Lgcxl Hoahh Uiflricl for DBlmrl le cM¢+mcr and/pr install the work 1 n dnsaitad.This epaliWlip b <br /> , o madu in ennMibuep with Sen Joagmn Cm my OrA'tense U <br /> Jr <br /> Local HweU District - / //-- <br /> w, Lot Size�6 2P_ PM-_— <br /> Job Address �.yu+- ----- <br /> Phono�-- <br /> Ovnter'a Name LL{"AiC4r-���LQ��7 <br /> �/ Z ?7 Addrnns phone <br /> License No,R <br /> Conti a Lor DESTPUCTION V <br /> FWELL REPLACEMENT ❑ OTHER ❑ <br /> + TYPE ct WELL/PUMP.Y NEW WE 1 SYSTEM PEPAI <br /> PUMP INSTALLATION ❑ PROP.LINE __ <br /> SEWER LINES DISPOSAL FCD. tl <br /> DISTANCE TO NEAREST: SEPTIC TANK __ L—PITS/SVMPS_ <br /> ' FOUNDATION _--.-- AGRICULTURE <br /> 9. <br /> INTENDED USE T_�PE OF WELL PROBLEM ARE CONSTRUCTION SPECIFICATIONS our ql Well Ca 'nq <br /> Monte <br /> D,. of of Wall Excavation Ga <br /> CI Induaum, ❑Open Bottum Ci �-_ Specifications <br /> C] cY Type of Casing <br /> ❑ Domestic/Po vote ❑GrdVal Pack TYDe of Gmut <br /> Il Other I'1 Dal+a pecth of Gmux Seal <br /> 1'1 Public Ci <br /> Surtaee Seal installed by <br /> III Igalmn -_Amxc nptb 1 Eastern State Work yy <br /> ump N.P..___ f <br /> I).-,- <br /> Repair Walk Done f] Type Sealing Material hop 501 _ , <br /> Well past mchair ❑ Oromeler <br /> t File'Malarial(Below 501, Z <br /> Depth_----- yg <br /> available within 200 ISO( <br /> TYPE OF SEPTIC WORN: NEW INSTALLATION REPAMIADL-I110N j DESTRU-C/TION I I INo sen c sYstr +per tion I p h1 c waver is i <br /> Other.IJSyJila..�9c.�d'�'°•A!'nry S <br /> X Commercial— / <br /> Icstallalion will servo: Resident°_- <br /> Number of bedrooms� Water table depth �°r <br /> { Numhor al living units: __/ <br /> rC. Character of 86 to a depth of g feat: +' ^ Capacity -.—No.Compenm°nU <br /> SEPTIC TANK C.1 Type/Mlg _ Method of Disposal ._ g <br /> y. <br /> PKG.TREATMENT PLT.OFoundation ProbadY Line <br /> ,. Distance to nearest: Well <br /> /` 'In�/� Total bngtNzin.-J <br /> 4x 1 LEACHING LINE (/ No.R Length of lines sZn l 16�T "'�_. e <br /> 1 / / 'PraDedY Line <br /> PoundaOnn_L�--- <br /> FILTER BED ❑ Distance to neareac Well -.QLL- <br /> t —.T—_- <br /> w cixe,lln.a->:—�--�'-Number. _S <br /> + SEEPAGE PITS I I Depth eI_-=lis Property Ln <br /> SUMPS I(V Distance IS nemase Well,Lf2aE_ + <br /> Foundation--llJ— <br /> DISPOSAL PONDS L. ounty o d antes,stare b s i tl $} <br /> �,_' t I ISPOS certify that I have prepared this application and that the work will be done in accordance wth San Jpaqu I shall of <br /> a 1 Joaquin Local Health D7trict. rlormance of the work to,wh ch Ihls perm t n Issued, p. <br /> (Pubs and regulabona of the Sen Joaq g atm 183( <br /> s "core owner or lie ensed agents signature cedillas the plowing: ceNly that in po sons subipct m workman's compensa <br /> emplpy any Per°°n in such rronner as to become sobject to workman s compenwuon taws of California,"Contraps,,, h tin fir ur wo,ktra<ling s g <br /> d ' • a.PCruptDY the following: I ten IV that in the performance of the wink for which this erml[is issued,1 shall employ par N <br /> i Ia fC tion law.of Wlifornia." / Lit <br /> The ePP1icant mus cell for ell required inspections. ComPlole drawing on reverse sdn. pain: 1✓—��"'y �/ /E� <br /> Title <br /> S gnatl% s <br /> FOR DEPARTMENT USc ONLY t <br /> i (I /li/ Datel Arae <br /> „ APPIi rlon Accepted DY F' <br /> oto n l l spac+ion by <br /> rout If£pecbpn <br /> x2. Li� 83 6Ci8S ems i.3r5* 7 -u <br /> ¢ <br /> Additional Com ells _--� n'�IJ Ma ce 027 710a ❑T acY &95(1305 f <br /> Lodi 255' 1 P O. Be.21X)9, S,k CA 95201 E <br /> Stk 466 6tur O. I <br /> Applc°nl Be <br /> all copies to:Environmental Heelrh PermitlSemcoa 1601 E. Hnzohon Avp.. 4 <br /> '.� -��q-N PECEIVED 0Y -DATE PERMIT NO <br /> " FEE AMOUNT DUE AMUUNT PEMITTEO .. <br /> (NFD vJ Gk O T 7- s-8 8y is <br /> -- Ee f 1a .6..aMfi.+ arLe7'.1l414d,.�' <br /> t <br /> d 6' aN4q P4 'j,'J• <br /> All <br /> °p �` RaJYb YS yea <br /> JI-i, f r� oJ r^ F, +sdS, <br /> A1:' 1,_. <br />