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; .�APPLI3CATfON� PERMIT, r a .
<br /> `n SAN'JOAQUIN`LOCAL'H FALTH DISTRICT.
<br /> 160.1 E. HAZE&(6N AVE:; STDCKTON; CA•
<br /> Telephbrie:I2091;- 1 5, :} t, +
<br /> PERMIT EXPIRE$ t YEAR F OM DATE°ISSUED {
<br /> T`.i:p44; �.Z4: 7-77
<br /> `4. 4s. ..
<br /> kyr +6{ (Comp�llete'in Tri licate
<br /> =Applicatkx)R..h el-ira1�f,�Ithe sti. Ql��nt l I�VIN�At! f..T�5 an�F Irt�talli4to 1 �auin Sa
<br /> made'in cpm Nance'vviih «# Coun istrits � appllCatk�n,is
<br /> tRoaq N Ordinance No 549 fpt or No. #862 fo:well/pump tigd the Ruleaertd#iagulatior�s of the Sari'Joaquin
<br /> Local Health Disv.
<br /> trict:
<br /> Job Address G City ' Lot SEzs PM
<br /> Owner's Name Afir= Addresrr' nW` Phone `2'a
<br /> { z�
<br /> Cgntrac'for -..�.. _, � aitla=SJZ2G1' P 'yilL�`-
<br /> ?.'y-
<br /> TYPE OF WELL/PUMP: NEW.WELL ©.. . CWELL'REPLAC MERIT 0 DESTRUCTION 0
<br /> PUMP INSTALLATION O SYSTEM I 1EPAIR 0 OTHER 0
<br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD, PROP. LINE
<br /> :.- .�ar,.,..P° ;FOUNDATION.: AGRICUL7U,RE WELL,. OILIER.WELL.,_ ^ .-n E/,SUMPS:
<br /> INTENDED USE`'. ' TYPE OF WELL PROBLEM AitEAT` `CONSTRU }IOf+!SPECIFICA1fO�IS a
<br /> r1
<br /> 0 Industrial D-Open Bottom p Manteca Dia, of Wel Excavation Dia. of Well Casing
<br /> 0 Domestic/Private Gravel Pack ❑,Tracy• • Type of Ca ' Specifications
<br /> ri Public Mg1i ►1 ,, WA�,,x.
<br /> In Delta Depth of G out Seal _ .� Type of Grout. ?
<br /> I I Irrigation �J Depth I I Eastern Surface`Seal Installed by
<br /> Repair Work Done' 0' Type of Pump - n 'H.P.. State Work Done
<br /> Well Destruction :.p.. Well Dierneter ?Selling'Material (top I
<br /> ` nY �J..;- -'�l�,nt��v �.. i_� �- ,�=,'„'s, .} t�-'�r � �'• a -,..*�»,� "w ...: ,..r., �,,-'s � r`. k� " h ,;+
<br /> . 'Da�th :. ,Fillet�Matariat:l8elow,. )3 �` r }
<br /> TYPE OF SEPTIC WORK kNEW INSTALLATION!1 REPAIFUADDITION•I 1�D5TRU6TION I rfNo teptk;system per�ttad 8 puWK sewer is rri
<br /> 2W
<br /> Witfllfl _ feet.3 ,
<br /> a �In>ltaq�tit�'w817lsfUB� -�N,'e����vR„�> .^r°4^� h' ��- ,wµ.�-4•rfiHYs ,kw�3 d.i 4�- � sF�f+. 3�L.,•s�`4• _ i�yr 4.'.
<br /> f
<br /> Nu 4 u�titier
<br /> e -Y --Characters ;oUtla8t0
<br /> ' -'tr feet:i't �'�� �rY� � � � a ?^ L. „�..y �+ '#� i•�'r"'S�"y'1` a-t •, fn„r a,.r.} L.
<br /> �t7'! e "� / r' t ,Kr�?,.�+•r•c.w.. 4 +.�. l 4 a-+ric. � ;;; I
<br /> i Q
<br /> s'1.5����.�
<br /> ..,tea .... �f �'")"' .'�'- { •'T.,`"akk '" ywa • ' � l�t` ." 7C^"'�'�!y• ` ( !� ;
<br /> t } Distance t0 nearest r+ '.'—'TProperty Llrts n Y� >
<br /> ....,,..A., 7.F-;-r,r.Arfi
<br /> LEACHING LINE i [ 140 8 af�6nett 1 r Total u
<br /> FILTER BED r EAeera>tt.I Well + Foutlda ' t }w
<br /> � G+�.9 � 2ws iyE ^� } ��'�^�'w"'�'!�y'¢;� B � - t 3 C i'' „•YL 3 � f •} Y t .F
<br /> -,�.ssxr -:a S i-.< z..,vn a.74 �ra .,;.�?a�ai -' x•+�.t� :<�„ 3'f'"�lw@"`�• T�+r,�wYa.•+.yr a fi-. .. h8 a� 'x 5i,� %"t'N- .° ..:wr:-w 'r�
<br /> SEEPAGE P ,`iz�y`I ._- ih " ,, Sri,, r �a}, ,..•,rr� a -�,� Number r +---a £ } - - i
<br /> 1 Sf:IMP f A "� rtt tai# IlstarlZ6,t0l7BarGl Wt♦11 73 F yrWttdat Vit+ �lOdlFLilte� �. e
<br /> ti 'DtSPO$At:PQNDS?�;I ~i ' ' " �?•� ' ,y „�;, r `c � r�y a„ate{ wT F� .•,? M ...
<br /> l hii�r�eby (heina� psrbd thAt + +�)k tliriq be in o4c, once vyitlt art.loagttin routttyiordfrtartces,state,laws.and:
<br /> if, Brt[f reSU
<br /> elatlt�yr_l_l_Qi},IIl11�.1tlat lln LOZ�1 t' 1 t c j " E {
<br /> ) eM ..�w"�'.�';�t'I�•ft�e,.�t .�xpk.�o- ��•S'T.IW�Vf�,�, i'-^�'f W�:�,�.Iq.� F 15t��.r, f.
<br /> car he t pr
<br /> bet�rne wbjecE't3 w ►`s of Caldo'ttlajv
<br /> ' Cartuactotri hkinp or aub�cori
<br /> t i ntkmar
<br /> 111110►R the r�Foritlttt whletttllls n issued I Qy�QfiOn;pJb�eCt tO M�Orkmarl i Wa
<br /> A"
<br /> J,
<br /> rig �� � Ya •%" � 5 s' nr .' r °�w •+� '.�. t� �r�'� 3 .�
<br /> APptlCetfon Accepted;bj+�"3
<br /> ti � 'e : ,)11 J :. E • i . Area— _ ..._�..
<br /> Pit or(Ira utlrtspection.bY _.;= =f�sle, ._ Fina Inspection by. Date
<br /> .,Additional Comments
<br /> O'Stk 468-MV7 ,.
<br /> D Lodi ;338x1; 0 Manteca 823-7104 - ❑ Tracy 8358M '
<br /> Applicant.- FletUrn all coplea to. EnvlronfnaC I Health Permit/Servlees ISDt.E. Ha3efton Ave., P.O. Box 2008, Stk., CA 86201
<br /> FEE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT'NO.
<br /> INFO
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