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_ APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. HAZELTON AVE- STOCKTON, CA Telephone r-- Telephone (209) 466'G781 +` pY PERMIT EXPIRES 1 YEAR FROM DAT_ EISSUED (F _--.--- r (Complete in Triplicate) permit to construct and/or install rhe work herein dea21 This of M Seapplication oaquin i'8 Appikalion is hereby made ro the San Joaquin Local Health District for a pe t'y m>da in compliance with 5>n Joaquin County Ordtnairce No.549 for sewage or No. 16621or well/pump and the Rules and Rpu I Local Health District. k�gW 'T(h9ey Lot ii:e�-- PM -e ` Job Address .�-1800 CORRAL (-�p _ tiiv---� $35 Address �Ry _ Pho- Owner's Name �•C-�—�- /+,� L �So 3vTPu4/ AVE _Lkeise No. ; 9 B Phone TM ( 'A(Zpas 16 Address } Contactor WELL REPLACEMENT ❑ DESTRUCTION ❑ , ' ;.� TYPE OF WELL/PUMP: NEW WELL ❑ OTHER O SV STEM REPAIR ❑ PUMP INSTALLATION ❑ DISPOSAL FLD.�— pROP, LINE DISTANCE TO NEAREST: SEPTIC TANK SEWER LINESPITS/SUMPS - AGRICULTURE WELL OTHER WELL — s FOUNDATION INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS Dr of WaN Caauq ❑Open Bottom ❑ Manteca Dia. of Well Excavation 7n.y;v5 ❑Industrial Type of Casing��— SO�/frJtlom ❑ Domestic/Privets ❑Gravel Peck ❑ Tracy Type of Grout__ ❑Other ❑ Delta Depth of Grout Seal I-1 PublicSudace Saul Installed by �- IrripaYr r —_ADpox. Depth I I Eastern H.P. State Work Dom Repsk Work Done [2 Type of Pump — Sealing Material(top 50'I T Well Destruction ❑ Wed Diacoele: . Depth Filter material(Belo 50') - IIIrnutted if puNic NVM leFkt -!availablec Sys 200 leetl TYPE OF SEPTIC WORK: NEW INSTALLATION I REPAIR/ADDITION DESTRUCTION I INo saptk systam W s J ' Installatan Commercial_sOther willserve: Residence! ✓ _ Number o1 living unit: Number of b�AV' s.•!J Water table depth Charictar of it to a depth of 3 feet Type/Mfg No.COMPIMM"in ❑ Typeg Capatiry SEPTIC TANK Method of DisDoeal t PKG. TREATMENT PLL❑ foundation Property Line I i.. Distance to nearest: Well . I Total length/size I LEACHING UNE No. 6 Length Of lures �l.�— ation property Lira FILTER BED - ❑ Distance to ncareac Well _ Found Number t SEEPAGE PITS III'Depth . . 'Size SUmotion:MPS '1 Distance tmotion: well___— Foundation Property Line DISPOSAL PONDS-- ❑ tun laws arW that I hew prepared this aPplicstIOn and that the work will be,done in accordance weer San Joquin county ordr 'ncea, 1 I hereby certiN this parr:.:is Yaued,1 ahM rot rules and reguletbru of the San Joaquin Local Health b1°win T cofitl'that in the peHormanee of the wd enc which or aubtpntraclYq slgrulMAi.�1 Home owner Pr lice rl agent•sighe g"` on employ any poison m such Monitor a 1O�O°re subject to workman's mMPenaetion lows of CebtI"I CploypaoKe ltiruq to word"'carnpul0- certifies the following:"I certify that in the performance of the work for which thin permit is issued.I dull employ pareses subject k tion t'swa of California..: The SPpllont must for all required insl�ctbns. Complete drawing on re�tae aide. 8 b tCfL - Dan: Tole:_ Signed X : FOR DEPARTMENT USE ONLY I Ansa, 4 1 XAffData Application Accepted by Dan Date Final inspection `t Ph tar Gro:l Inspectbn bV rAdditional CO�t. C3 Stk a8BA7Bt� ❑ Manu 823-710/ Tracy _ �l- _ res het 3�-3821 ul Health PartniUServkea 1801 E.. duration Aw., P 2(49, Srt., CA 9B20T . Applicant-.R/alum all copleato: Environmen RECENED By DATE PERM"NO. EE AMOUNT DUE AMOUNT R--- 111"in ( �o 14 il-711 law 11 5� 7 in 4 ii. A{F�'.N"wI �lP�vl N YIt AOW a d 'S=`, . SF. »". 'r. )':.a ,LP6IA'$n3 ra.rYk9. Yfd.Nwf4Y+.SINWMWYcY.Ytra'xrN�#an'. :'�a° .6f.H�`F .y'RT(if. ..r`P6..r. ..r