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hry' 'r�.zpl�- <br /> t, Yj -a'; +."IM�4 { `Ln,4�;'d� •4�it+� `'� fE - �. .r4 �q�ic'tis'a. <br /> ,.:l,•L.S_y�" pr� "'�i�;�r"� -ac;�;T. �'ybi i , �'1,� F. ,� _�✓. � <. - ° �!'-'H`x P !'Y ;' <br /> • ➢ q <br /> t a �^r «'= <br /> APPI.ICATIOWFOR PERMIT > �;y <br /> r r,tgi8AN�JOAQUIN,LOCAL.HEALTH DISTRICT j F <br /> rg 18g1 E. HAZELTON AVE: STOCKTON, CA � � <br /> m �b�Teled '120E1466.8789 ,'��` <br /> a <br /> PERMIT EXPlRIEB!',•YEAR.fROM DATE ISSUED <br /> e : <br /> (CCflipldl�WT �4 <br /> r <br /> Appliadim Is hereby ntad/so tla Sen Jot An Loom Nomm DiWkt for to pamat to oonab'tid and/or ing"tit/work herein dsSedb+d.Thk <br /> ^' m►'PBarloa with San Jo/qukt Coon r•Ordinsnor No.81B for a/crepe a No 18LEt for waN/pump end the Ruin and <br /> Loral HsMdt DietrtL ; v 4;{ ;.r Repulatione Of the San Zoom T b <br /> S jot V '; 'gM '<�rT T t; t�§?, s <br /> Job AddnsS Lot Size PmA. <br /> • D WOK'// _ - -ix:��'^k' '.r •f�IL�� sfi <br /> r _� •.x�wvl� ; Phone �1+!•1 87� �, }: <br /> t �i y } fi1,Ci�s�f,6 �yy <br /> L.Icense No. Phone <br /> TYPE OF} WELL/PUMP-. KEWyIELL O 3 ELREPACEMNT ❑ <br /> DESTRUCTION a t <br /> A iII10 NUALLATION (3. i i C a WWREPAIR.❑ ; ,; , OTHER JWD /i'M <br /> DISTANCE 7O NEARESTs SEPTIC TANK v ' N <br /> ti F� + LlkE6+.�.._� DISPOSAL FLD. PROP. LINE <br /> F UNDATION rr rr ' <br /> AlLTURE WELL OTHER WELL PITS/SUMPS <br /> FEE <br /> INTENDED USE . TYPE : ;pRp ARFAR+',.CONSTRUCTION SPECIFICATIONS <br /> f <br /> 0'Op/n'9om" .�i William" ir^Die.of WWI Excsratlon r1 <br /> E7 Dia.of Wap Caaft . <br /> Damestie/Privet/ ❑Qrarsl Pack r(3Tracy �� , ¢r 7>rp/W Cal <br /> ❑ Pu6fic ❑Otfar'k Ddti "t D.pth•of.Gnout S.al Specifications r�'• <br /> ❑lrtip/elOn s '• Type of Grout <br /> �APP!wt.Depth^�C]Eaetwn f Swfaca Seal Ilr/tar/d by'' <br /> Repair Work Dan/ ❑ Type of,Ptlmpya'x• r a H P; Stat/Work <br /> Well Destruction . .❑ Wdl Diam/orr�' .$Mpr�Y fYfstniai`hop ivj Done <br /> 4 R e <br /> " • <br /> Depth `. '��AwsrfNalrrf.IIB/Iaw60') . ,�,,yhJf �'P� f <br /> TYPE OF SEPTIC WORK: NEW INET TION O ,REPAIR/ADDITION❑, UCTION INo <br /> Septic system pern►itted it public sewer is <br /> Itntahtion vA carve: available within 200 feot.) <br /> Number of pvfnp unite: Hamish of <br /> Character of cop to a depth of 3 feat <br /> Water table depth <br /> SEPTIC TANK 1] Type/Mite" v � <br /> PKG.TREATMENT ALT.q <br /> H _. No. Compartments " <br /> Method of Disposal r <br /> f' r D4talla/t0 raile/C 4 <br /> ;.."'W" <br /> ' W" Falmld/dart Property Liner <br /> LEACHING LINE C No.lE Lertg,i,of lines Toad 10npth/sizeJ. <br /> FILTER BED Cr Distance to nserast Wep`$ Property Line <br /> 3 l.' <br /> i <br /> SEEPAGE PITS CJ Depth lace ` Number <br /> SUMPS ❑ Dkumm to raresr won Foundatbn <br /> Property Line q <br /> DISPOSAL PONDS ❑ Yy 4tr,i' <br /> I hereby certify that I have ; + Y <br /> rules and r fx/perod this apppcatlon acrd that the work w1N'be don/In with San Joaquin county ordinance/,stats WM and' <br /> ` eVin ions of the San Joupdn Local Hseld Dkttritt 4 <br /> Home owner or licensed <br /> ap/ru's ripnatun asrWies tits,folowtrq� 'I certlly Nrst in the psrformsnee of the work for which this pem8t is Issued.I slog net�A <br /> employ any Person in such m/nar as to,bioatle.eubject to WorktaWs oomipsraatlon I/Yq of Cdiiarr,ie"Contractors hiring or eu <br /> cert3fie/the fvpowktq:"I that in the performance of the work fm%to ch this pertdt Is Issued,I Shap employ persons su b acf4g sipn/mn45 <br /> tion laws of CalManla." 5-4 ;ry � blast to workrr+sn'�nompsra/..���1' <br /> The apppcant must Gr all nqukid Complete dr/whrQ'an mm <br /> ras lids. <br /> i L�Accrwu <br /> MIMI- <br /> "T <br /> SE ONLK d byApDate Area }t . <br /> Pit or Grout I DsYi- Fkw impectbn by p <br /> w 1% <br /> l Additional Cornrnenta. <br /> Stk 488.6781 ❑ 1 Mantes 04 ❑Tn y- BW4M <br /> Applicant-Return ap copies to:EmkomtantN Health Pmttft/Senses 1901 E:4azelton Ave.,PA.Box X M, Stk.,CA 1 Y <br /> I } <br /> DUE AMOUNT RIMFTTED <br /> INFO RECEIVED 8Y DATE PERM N0. 4 <br /> E 7 (REV, aGl . <br /> EM s+id <br />