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- APPLICATIO.0 FOR PERMIT A <br /> �, 9 <br /> 2x- DISTRICT <br /> �s A R.,v LOCAL HEALTH <br /> SAN JO Q <br /> 1001 E. HAZELTON AVE.; STOCKThN, CAq,� <br /> Y Telflplto^�120.41;�8�6781 -�p <br /> PERMIT EXPIRES1 YEl1R'FROM DATE I88 <br /> jl9 F� ' <br /> Application hs hereby made•to the San Joo*M Local Health DWOM for a pem*to Oor111111 al endlor' 11ro dsr,ofbed.This rppOt edam i' <br /> 'mads in Mnpfiance yjith San Jowdn County Ordlinoin a No.50 for nwo0o fx N0.l1088 for wollpdp end tM felbrteel the Swt Joerni <br /> Local!isalth District. Rt t rr # �y - <br /> ' k PM <br /> Job Address —0o L�,,J Loi Biao <br /> iii'y.�L 1-700 -'•^'w'��� <br /> phot <br /> Owner's Neme�= A�*erlaq IO' SSL 2 � -Z I <br /> R ��{ �� Aole� <br /> 1 • Contractor �Ct �IONt Address ,fL '� r Lkense No.-y Phare h <br /> TYPE OFWELLlpUtutP: NEWWELL7 M WEL4REPLACEMET[i (]t,'+► .- OWRt1C71ON-C <br /> r ,tx <br /> w PUMP INSTALLATION t'3 �� �} SYSTEM REPAIR �, w OTHER �"6'IP�M'orYAori <br /> DISTANCE TO NEP.RESt: S >.�EPTIC TANK ..- SEWER UN IES r~ S} Df--- `,>�15POSAL fLO PROP•L T•�L- <br /> I DUND1tTK3N 1• A+dRICUI TORE Wd.L ZiI .OTM M VALL <br /> INTENDED USE TYPE OF WELL'OPROf1LEMAMEA , s ci►TONST ,4 <br /> ❑ Industrial C]Open Bottom fir, 019 enten — 4DM a�MhM.dNfe ta"4•`�.�..� Dlo.of Mhy Ceiq <br /> 'k ❑ DomestklPrivata ❑ Gravel Pw* XTww�;jw b hV.,Typeof <br /> r4r Y5 __' of 0.6 <br /> _.. <br /> �- �v► q Public u other O Delle 1",,o.pah�c3fotA Seel ._ Type - <br /> C]Irrigation ---Am=.Depth `�EaoUsnt Surfeo�$MI Mt*ta d l� <br /> n jke ,1 Re ��I3rrWork Dona ! I Type of Pump H.P. ` °- S"YMbfk Done <br /> • r""• eslru:tiCn C] won DiMneterr _.T�.: SeMnp MfrtetlM(toe - <br /> ( r. ap IO rtvF?0 ru Depth 4 Ii4- FiNer MatefW(eebw!D7' n r <br /> TOF SEPTIC Wr`^K: NEW INSTALLATION 0*ItFPAN11ADDITION -DEB7wUCTIGN.� INo k lrEtiic www M <br /> YPE <br /> :;' Y is t- .t � �•_,. e <br /> i Installation will soros: Roside:tce_ COV-0-0 _ 011tH <br /> I r� a. F F EF1 a4:� <br /> Number of living units: - Number of bedroonto <br /> Charoeter of soil to a depth of 3 fast: <br /> SEPTIC TANK G' TV"/MfgpCpedtY- N0.Caftpesrrlsrtts <br /> PKG.TREATMENT PLT.❑ r fl t+' M of Dlopoeel' <br /> ( A " Distenee to f*MMt. VM <br /> r fC:attletlon _rPfaperty Lire <br /> k. LEACHING LINE ❑ Mo. d Lerto of Rn a Total Mrtpdt! s <br /> FILTER BED Q Distor+oe to nlNfeet: Wel FOYlldellarr Prapwty Lite <br /> i SEEPAGE PITS CI Depth ------6—SI>o ; 1 Ntfmber r: <br /> WM I i Faurrdetlon' 04!4- �­ti l4oPorty Liie <br /> to nearest: <br /> SUMPS u Distance F <br /> a DISPOSAL PONDS 17 i <br /> w I hereby Certify that I have prepared this epplkotlon and that the tMork will be donne in aoourdalrae whh Sw1 JoMluln aatrntti ardrreeroee.stats ILA . <br /> 1 r <br /> rubs a*d rsgulttbru of tlwo Sen Joaquin Local Heetth Oise'iCtdr,. •,. "` .,. :='"... "` - ' �•v'- <br /> ,:.. .- Home rar:vw w Ikensed agent a sigrtlture owtiRoo IM folbvrkfg "1 ow4fy ltiet k1 to peffofrtrwroe of 1M warn for teAtkh 1NIM pernllt fo Issued.l ellen n. <br /> ;arson in such manner as to boeorrl1 subject 10 VMdwrwr'a im ONtntlort bVis of Ceiforrlio"Cottenesor'e hNnO fx eubeorntan's c��. j <br /> cert:':U„ :_ •avowing:-I certify that in the porlormmice of tiro wont for%Wdd t1d+p mm Its Mewed.I ahM employ pirsone wr0�oct 1owarbrmn:oongrra <br /> tion ; s at California.- <br /> The <br /> scant must call for all requited on rev" <br /> •, The applicant req lnapectiot►s.CampMte tkewMtp <br /> Signed ry �'• Dow <br /> Fr'.:!DEPAR1MfRif IMS ONLYjut <br /> i Application Accepted by _ Date Am <br /> w i, H s46 <br /> dllte - <br /> i Pit or Grout Inspection by I .,. Dote Itie-oeft 1 by` <br /> IAddhiona!Grnnments: t LsL .~ - <br /> '. C Stk 488$!81 ❑ todi 399-3821 (3 7101 O Tmclr ; <br /> x Applleant-Return all copies to: Envlrwmw-te!Heoih Pwn 18orvkm 1W1 E.HssMton Avs.,P.O.Bare 2ifC4.Sdt..CA son <br /> y+ FEE AMOUNT rxl! T AMOUNT"Hely rMI) IN DATE MRWrNO. <br /> 000 <br /> )j g4V-31. b.Ew IS7�IIIEv.,�ea . 4 ��-:. v✓1 � - <br /> EM 14$6 • <br /> ; ,, 9.," tiY Fy - p fid`• r ta`'?l,�,'� g `t M '}; t'z,� .:� <br /> '^�e.�'-.'3Y�•.' _ ' 4E`+' `1 ; 4!'I F 91r:`a o-� '-+i-• . <br /> E .. <br />� ^'..: •���.,- ..'...:in a+ "-�}.r,••=..f«re!a,-.-i„!'+} .:'..n�s�rr•. 7!""o-",";'... <br />