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F <br /> f <br /> i <br /> APPLIC?.TION FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Telephone 1209) 46846757 <br /> PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Trlplime) r. <br /> Appkador,r.-hereby made to the Sen Joaquin Local Hoafth District for a permit to oartr-ruet and/or Instak inn vr• Frateln►daatsbad.This appNMdon,N <br /> ,lade in con..:attoe with Sar.Jottouin County Ordina:,Lv No.W for sawmW or No.IBM for WW1/pExfCIA <br /> Local Hearth.+strict. <br /> lob Address 2324 Navy Drive City Stockton LotS4a_ PM <br /> Ow aNarneWester Stace Steer, Addrna 2324 Navy Fhpts Orive 944-9561 <br /> - - --— - _ i <br /> 1 <br /> eenaaetol'sName Clare Well & Cgvi.qk..No• A-371560 Phone 462- <br /> 5597 <br /> TYPE OF WELL/PUMP: NEW WELL �A WELL REPLACEMENT C DESTRUCTION O I <br /> PUMP 114STALLATION OR SYSTEM REPAIR 0 OTHER O <br /> DISTAVCE TO NEAREST: SEPTIC TANK IS _SEWER LINES ISO DISPOSAL F1D_ PROP.LING t <br /> FOUNDATION AGRICULTURE WELL ,OTHER WELL PITS/SUM .� <br /> INTENDED USE TYPE OF WELL PROSLEMAREA CONSTRUCTIOfJ SPECIFICATIONS <br /> ❑Indtrsulal Open Bottom O Mantaq Div.of Well EattaysMortD&of WEN CS*4 d /8 <br /> *00" Mdc/Prlrata Grevel Peck O Tracy Type Of Caektp Steel <br /> ❑Public O Other C1 Delta Depth at Grout BMI Type of Gton1 <br /> 0 Irrigation 15 0—Appi o . Deosh to Eaetem swims"Insum tw_."ArkWQJLA �d <br /> Repair Work Done ❑ Type of Pump $Ub— H.P._ ,. St"s VA*t Diane—Irl& l..�,........ 1r <br /> Wall Destruction ❑ Walt Diameter Saeling Material(top 60'1 <br /> Depth _.__. Filler Malarial IBalow 60'1 Jr <br /> TYPE OF SEPTIC WORK: NEEM INSTALLATION 17 REPAIR/Art)MIJN 0 DESt eythm �1 pim wow is �f <br /> Installation Will serve: Residence- _ Commerelal DOW <br /> Numbs of raving units: Number of bedrooms J <br /> Character of sod to a depth of 3 feet: _ Wsiar 1"depth <br /> SEPTIC TANK ❑ T%va/Mfg CapaplRr NO,Compatme" I <br /> PKG.TREATMENT PLT.0 Mediad Of OIIp" 1 e <br /> Diatence to nearest: Wan Foundation Propatly Line • l <br /> LEACHING LINE C) No. A Length of Imes Total laingth/oW <br /> FILTER BED O Distance to nwt'est: Well� Fo u Walt h - PK"M Una <br /> CEEPAGE PITS 0 Depth _ 5lto Nufty <br /> SUMPS -C Olatsnco to rwa,vsi: Well_ - Foundation— Piopslly Line , <br /> DISPOSAL PONDS C7 <br /> I hensbv certify that I have wepered this otinl"ikof.nnrt/hat the work w111 tre done in aetorc" with San Joaquin tounty ordktei am state ktwa,and � <br /> rules and regutations of the Sen Joaquin Lreai Heath District, 2 <br /> Home owner or licensed rgent's signature cv iif4ea the loVowing: "I rerllfy that in the parforrnanea of the work for r#Ich thla pp ft' Is Iwtwd.I sho ilei <br /> employ any person in each manner es to tIPCO a r,ubkt to woArnam's comparnedon Won of California."Contrsatort hiring or tub-corevictktp nlpnaAvw j <br /> Mrtfflaa tM f :"I tertlty that in the rWriMmance of the work for which this pens I Is WeLed,I shall of i0oy Poem roblietl to wwkniWe oarrtpartltw <br /> tion/anus of <br /> The.applicantcannier nee tirtd e�c-wi womplafe drawing M raysrns etch. <br /> Signa __ — Title: S3i —Tree . 17 3uno 196a <br /> Fon DEPARTMENT USE ONL11 <br /> Appkrailon Accepted by �1T�--1`._.--� Date Area <br /> Ph or GFovt Inspection by Dene rrw*tnrpectfon by <br /> ECo .•ants: <br /> k _ <br /> 0 Lodi 3090MI Menteat 023-7101 ❑ Tray S3&QM <br /> - Ratum ad Copies to: Environme*.tai H^phth Pomitl,%tvicett 1001 _, Hamilton Ave.,P.O. Solt 200➢, $tk.,CA NM <br /> CK <br /> tHfQ AMOUNT DVC -- —f.F10lJrlt nf.diT'Tt:p CA814 RFC[hfEDeY C&TL. i'LItMIYNo. ' <br /> b <br /> �s <br /> EN t1}•11FFV TOraeI• I rt I ,•. <br /> ��y 1 <br />- *•"�a to •,... , � '• _L_.�-------_.. .. ., <br />