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APPLICATION! FOR PEKMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON ON AVE., STOCKTON, CA <br /> Telephone 12093 466.6781 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUES] <br /> (Complete in Triplicate) <br /> F�plrcaUan,s hre,ehy made to the Sen Joaqurr,Local Hoalih Di iwt out a psmrit to conttfuCt and/or insiaA the work h~d"CrOdd. %h*0c"M� <br /> il4ft 04 <br /> mid..to conwi,drneu with Sar,Juo(lum <br /> rn Cri y Ord,nineu No.!.A9!w wilwige of No. jHQ for wellltwmp acrd the Rules srtd Reyule <br /> Local tiealth Drsr••..t <br /> ftA <br /> Jot)Address �y�a�r t-//. - City_gLaa Lot SAN <br /> Owner'(Name _S/1L%/ I L117t6 AdArose In�e1../K71.[✓!A��wwa---i' f'hdw 7w�_JplY�J!7 <br /> ContractscsT_IIA -- Addressa �iV4e + df��ltetLAe IY0 f�R / �Pti011li�rRc�J <br /> TYPE OF Wt.I-LIPUMP NLVi WELL CA WELL FILPLACLMENT i.1 Ok5THUCTtUN i 1 <br /> - y PUMP INSTALtATTION O SYST['M,REPAIR n WHER ik QOM Am• If <br /> DISTANCF TO NEAREST SfPTiC TANK /vA r `EWER LINES <br /> DISPOSAL FID. PROS.LINE <br /> y FOU-40ATION <2•��_ AGRICULTURE WELL J��_ OTHER WEtl11l FM751SUNtF'S <br /> iNTENDI'D Ur.f ^ TYPE OF PAOMEM AREA CONSTRUCTION � <br /> I I Industnrl I _ _.t Ovrr+tsottan _ d 10� <br /> i 1 Manteca— Drs, Of Wirt!Ertavalrun -- �, U <br /> I f DarttastrclPr-i'la 11 Grawi Pec 0 Tracy Two of C41%lrq � - Sj�iCr[rt:alwlnS <br /> I"1 Pu ,c 7tftsr t l-1 Dahl <br /> WDay►It of Gttwt Srto( __h " Ty"of IGtgot <br /> I i Irr.dal.un .- Ar4waa. Depth 1 1 k"twn Srutacsr Swot Irvtijed bri <br /> papaw W,rs Duns 11 T efw of Pomp H.P. S1,614 WO, Ik}IW_ - <br /> •Ar/f Soa>wn1;GAslwril tsep tb'1 »� <br /> Wail DaflruClu,n I I 4JrrA D.eenauM +� ♦ ) <br /> ptrpth _ _ f= fr,+rt klaWW4 W:,krw W) <br /> I YPI UI :.1 f'Ilt Wl11ia\ Nt W tN`,TAtLATION i 1 INtPAtitrArA'AfK)N t t ott;TRU T"14 IfW►srTttk sysMtt IfetrwtlaA r)p"blrr warp R <br /> rtvdtLt[W UrtttMA 31017 hwt.i <br /> 11twaMlrnn wrtl fa^w Rw 1104we^ CprllmetcoA— OWW <br /> Numimf of Irvwv rmob -_ Ntmdwl of tledtoorna - 441 <br /> CliwArtel of sur'Ib a rtalttn of]feel. _.. Wase tsbM f$Bpffl <br /> SEPTIC TANK t I Type/Mt, , C+st�'fi►-•-- <br /> PKG. TR[ATM(NT Pty 1 1 f�fiad°A Drlt�ofwM <br /> D.wms W ntwvkt. W49 Proveav Lev — <br /> LEACItitrf, t lNI I T Nn.•;L"th of 6nau - TOW fsr►ptV <br /> FILT[F HID I I rhfttm co to t'+fV too <br /> StLPAGt PITS 11h b.as --+�-•-- <br /> !.tJtrAPri I I (1.uartsr.to motow WtA FOuttdaeron_.��. ftbtoY LWA <br /> DISPO`.Al PONOS I f <br /> I Iwdty tart,ty nut I nova PrKsar.a Mos 1tiQlltauun tend IhAf dW V00111 11110A be d8na OR&C <br /> rYKh Sink 30eQtW►Catt+MV ordtliACtO�.'MiM brwtlr.Mrd <br /> tj"%Ond rrjartatn,rN of HM SAM,h?i rMn tr.Caf HoOhn D'U'41' - [i[f�MA <br /> H%yr+a gwrw rA I.t nn. j wwm s bvrtsAde cartww the Itr'.N wV "i Cwt^thAf_ttw parftrr.tfaftCO df t1»vAxk 1w vAdch&do Pwr4 Y rofiO4 <br /> anKroY w,y paruvr m wct,manetar at to twanr M,Igrct Ra vwYYwrMi i�yprt,+M+.:trart Lyvr�of Cawk7r►na' CAnY�CtOrfs hw+r4 O/subtaSrMr"Ch11b fr <br /> c.Ir1rN the I..rt.wr+p "I crt.ty thrN�Efts IrrEornriMfa.r rll the wOrit ear rr.ft.cn dw prrtrl*rauad,1 strlt anrsrtw ftttrsorra atrtrrrtG!tOrvWfttMN1•n..dA�MMe <br /> ton to-100 t.0111. <br /> iM aft(•r MI rm,u tsa eat/of trot PMZirOA►j GMhtrMa►d+ <br /> MeJII'y/ <br /> _ /far <br /> EOR pE PA Lft; 016LV <br /> /,jpDcat.orr AccM•.srt M .. <br /> �d1at UnpoemA e <br /> as a Groot InKytr.on by .,,,,_ -- DsW�,r'-'--^^- <br /> Addw.wurl <br /> L' Sts 4"6761 L7 LauaK.}.Iar2F Q Irtentaoe ="YiBA 0 Te'"y <br /> Apytrant Raton ap copra w' inworvtw wd11 it"Ih P4"r 15wv Ctli %0)1 Ksisttorl <br /> OAT€ /lMAMT no. <br /> Avs.,P.G. 1301( .Shit.,G 1 201 <br /> rte a M►DUIE ^16404".47 NbAITTib <br /> ^♦ ttELlhltO&V <br />