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h;rla.tnilaull At I irlrT <br /> f <br /> APPLICATION FOR PERMIT <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1Spl E. HAZVE TON AVE., STOCKTON, LSA <br /> Telephone (200) 46fi-FUM <br /> PERMIT EXPIRES 1'YEAR FROM UA*t'l' ISSUED <br /> Mornplete in Triltlirntf:) <br /> A"liitstiun is hip my mOdQ to tho ban Joaquin Local Ileelth nkirirt few at Iw ttAl1 Ire 4.Z■rytruvi mid/or InStad ttta w rat hoMin doc:ritictf. I IMA opp1110tibn is <br /> marls to QomokoiM Wilk b01%Joaquin County Ordinene a Mn.rA9 le"rr.w,Vm t■NQ 1862(us wall/pump arra iris R ori and i'topuWtiors)of tho F;aR Joaquin <br /> Lovol Hoatm utstrict. I .4 D',0^04 R1XV1 1 127(35" <br /> Job Addrass . .. CIiv-,'Rockt t Lot kiti k, Phd <br /> Awnrr'x Nrrirar 1NG&l �I 1X11 3 � 17�_ AtlAfv4t; ., Phnx■. 1 <br /> ��1 i I <br /> Cnr,rurcta W* DrillL _ _Adorvsc F-n• BOX t LirYmin, nsr. Nn rZ. PhunMi 15 -x395 <br /> TYPE OF WELLrPUMP: NtW WELL XI MQ W e T 10 4f5TAUC ION 171 - <br /> �. -- FUM!' INSTALLATION M 9 I1/1r5 +;! HLH G <br /> UISIANCE TO NEAnEST: ar.PTIC TANK 7W SEWER LINES CCC ! D At Pnor. I INF �_ <br /> FQUNOATION AGRICULTURE WELL 4��tJlItl1C71 INCI.I. NT913UMPS <br /> INTENDEO USE TYPE OF WELL PROBLEM AHkA LUNUTnUCTION' C K� N� <br /> L irWusirial O ODoR Eotlom� f7 MantaOo-_ DIA. of wap rkravai'Inh• talo. of Wall Gatirip 2�r <br /> Cl Oamastic/Private 0 Gtavd pack U Ifacy Typn ed C wiV PLIC SpeOifiastipn0 <br /> rl Pvbllc %) Othcr Sid Pack Ix Oahe Stlx'ktM fl"dir rrr(i,rtit s wl 404 , Typo of Uroul .Nftt <br /> I I Atlpation WLApprok. Depth l I Imlefn Snrlaw to lortallad by _ <br /> Rapti?Wgtk 0046 r) ["a of Pump �'tIt P Iiwe Work Dano <br /> Ard <br /> it tlOetfYCttoR V Well Diameter 'rte. $arlirry MatariA(t4¢W') . <br /> {i410n10Cring Well Depth 66, Flier Material(Below GO'r _ <br /> TYPC Or 3[f TIC W/1RK NFW INSTALLAIn N i I nr.r-Alfr OAUUIIIt)N I I E1t:;rnUCTIDN f ! t ,—.4.7'Itvm porml1119d it ot,bso vOWof is <br /> ovaiaela wit in 7I)t1 f.wi I <br /> InCtplle1110n WIN behrr: (fasidenee._ <br /> NY"V"of living units: Nwnle!r VI lwtkupnrs ~ <br /> Vhoro0t0f of am to a deplh of Z 0"I - -_Warr« I*r 4kpth <br /> $tPIIt; TANK rI Tyjm/Mryl 1:OnaeilY No. Copartn'Isrii <br /> PKC.TrIEATMENT PI T rl Math of DWWAI <br /> blmnces to rta"t: WCII 1'rwmrt:rr.„ti Property Lina <br /> LEACHING LIME Cl No, 6 Longth of Inas „ Tout lorigm/age <br /> PILtrR era U Ulatarlce to rwvwast. Wyll-..... POYrtaattbn t'repertY l' <br /> 6IEPAG!Pi I I$ I I Depth Site <br /> SUMPS LI DiitancA to nw ,.w Wal Fouodation » Property!;■. <br /> DISPOSAL PONot; Ll <br /> I 110tetrf gerlifY that I hays ILPr.i4wl Ibis appll<stlon and That rhe work well ttv pane in aocordanre .rid.AlAm Juw4i in county otdrnlnoar.,otol0 Iewta. And <br /> fulaa and mquletirinA nr If-*4N.I Ji w4ijin Local Hoorn ormat. <br /> Hafts Owner or i'ir rind rrlyynt'r siyonturr earti!!as the foWwrnp: -I portrtY that IA The porfnrry mcn r,if dol Wolk fmId1 pomwt is lashed,f she!nn1 <br /> ampby any prr urn;Ir aUcfr tnannsr as to IaYCofIN t t3bjAot to-O M A'a tompensa6m L—cd Califurnhl.”Con F Y, ` <br /> mato <br /> CMI(rtx dre f'AlQWhtg:--I Cat1NY TN;In th•perforrismoo of ltw Work for which thix .mis ri iYYuad.I Shan pmol po au laerlrs• <br /> dnn laws of Caf;fornb.'. <br /> TIM AmAi mt m a t for ON tggu d irwpootraria. U0AVIate drawing on u,+.�.Ma skiq. <br /> Signed X. frao: t`�T st pots: . 7-11-91 <br /> Qttl r�JA <br /> POR 06PARTMEN�eWit ONLY <br /> AWkillon ACMIad fayDale ! 'Area �I <br /> lift Of Grout fRepeatiort by M'"_- - Ftna1 IRapootipn dY betA 4� <br /> AatthEtlltel � . <br /> U 6th a86f3TA1 rl Ir,�rN 9ti21 Q M la 1W I 1 Trery IAWV ' <br /> AupNrarit.IlvtprR eN copes to: Fnvironmanial ttaalth Perm7tl;ero;r*y IIA01 E.Hasetron Ave.. P.t.. FfOtt 2DW, G.A., CA <br /> FEEA �p <br /> INFO MOUNT'OV% AMUUNT FENITTCD rrECEIVE6 iiV PFAruIIYNp, /� <br /> -Ell:ig14�tsEY.i,aei <br />