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<br /> APPLICATION FOR PERMIT
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> IWI E HA E:T ON AVE., STOCKTnN, CA
<br /> 'Toluphono I2091 466.67A1 I
<br /> PERMIT EXPITICS 1 YEAR FROM DATE ISSUED
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<br /> Owner's ,./ i,_.__ rr 1 L 7c.•41�� Ai r,.., - � )? Ll.._ _ - Phnn,•_.J..�Ll. _ — ..—
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<br /> 1--E OF WEL lfUMP NlAVVVE.LL i Wl'LL ACPLACE%IFNT i DL`.,1iillCTI0N [
<br /> PIJN*P INSTALL-ATION SYSTEM REPAIR i OTIff:R
<br /> T1ISTANCE TO NFAR"T: SEPTIC TANK SEWER LINES _ _ DISPOSAL fLD PROP. LINE
<br /> FOUNDU QN ,- -_A_ __.-AGRICULTURE W'Etl_ ,...0IIIE:'A WRI PIT5,iSUMPS
<br /> INTENl141D USE: M TYPE OF WELL PRD6l FM AREA CONSTnUCTION SFIFf If ICA110W,
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<br /> 1.1 Open Ratlom , i hlanleca Dia of Well Ercimition era. of Wrli Casinci
<br /> t Dnnresuf�/f'nvate I i Gravo•I Park € i Tracy TYp'!of Cas'nrt _ .. Specifications
<br /> p4s"ir, 1 1 Oihi.r 1 ' 00ta Ocflih at Grra+t Srnl -_ lype rel GrOUt
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<br /> linpaa TArffrk Oone c 7 lv:)n of Pwnn .._._ ._ It;'. _. State!1Vork {lone• _ .. _ ...__ .__. }},•/•��
<br /> Wall Drsiml.:trnn Well Ormnetef ... _ Srrihng Matmol tiolr 5111 _ .... ._
<br /> Depth_ {,llm NlAterial MMow GCI'! _
<br /> I Y1,t. 0! SI-I'TsC WORK. NE W INe.',T At f p flON ! 1S LIP AM'AGM I ION i t'_I'.SI R4It:I10N t : IN t:rpI,v.syyten+pranr,m•et a 11,,hI crrwrr rs
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<br /> Instagaltmi it,sorvn,: Rrtidenre C,mcnercial _ QIN?• if
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<br /> NaiMW;Of IswroD ufbfsl ._____._ Number 01 bedrooms -
<br /> CharaLlwr of sod to a depth of 3 fent: C--w. ,__ _ _ �•• W"I" labin depth -„yr• ,_ .......
<br /> 5EPT1C TANK l i Type/Mfg _ - unar,rryY e �^ Nu CnrnttrstnK•nt9 _. , ..
<br /> PKG. ISCATMENT PLT l 1 Method of DI7,wsal
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<br /> LF.AC:HIMG LINO !I NO $ L«n41eh of fines _ a3 lu!:d tenE7th'vt _ __
<br /> I'M If R{LED I ; Divance to nnnr,iiv Wd't I ounnat.11, p,nitntty One
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<br /> OtSPOSAL PONDS l I
<br /> I hotet7y ca!--dY that 1 haw)p,gnmiwi tf,n appliCA!ion and that I7en wn,k wltl 1v1 ei'm'.if,.1cemefanel,N4tll'-vi.lo let ilio i;numv clufmancor, Slam laws, anal
<br /> Wk."Arid f9VtalJt.Wnu ni Ilia San.Joa,nt:n LOCLI Health()mftrt
<br /> hi,wM ownpr oi licensed nip.nt'i s-govittra CM11110t ole falinwrnq' ''I[Crtrty thnt,n the priforninnta u!Ilio wr,+k fnr,which this pm.nit g tssuod, I shall not
<br /> ernot)V any person,n sysh ounner as ro hocamn tvhgn:t to wnftmm%s compenrratnff,Incas n1 rAlWormu (,Imonr-roe's twu)q nr•,u')cnntrnC•tinu r.ignature
<br /> I cerf:fles the falrlwrna."I CUfltfy thxl in thn pilfimmance of the work Im whrch tfns twmml iV+LA;10d I vl ejll(,niftily twFM')ns Suty Act Inwtirkman s tomppn5d
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