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FOR OFFICE USE: APPLICATION R WELL OR PUMA' PERMIT PERMIT NO. 7 L -( <br /> (Complete in Triplicate) Date Issued: i <br /> IS <br /> PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> APPLICATION IS HEREBY MADE TO THE 'SAN JOAQUIN LOCAL HEALTH DISTRICT FOR A PERMIT TO PERFORM r <br /> THE WORK STATED HEREON. THIS APPLICATION IS MADE IN COMPLIANCE WITH COUNTY ORDINANCE <br /> NO. 1862 AND RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. E <br /> JOB ADDRESS/LOCATION: 2250 1audman Ave: CENSUS TRACT: <br /> OWNER'S NAME: David Ives PHONE: 477 2712 <br /> ADDRESS: Same CITY: Stockton <br /> CONTRACTOR'S NAME: J. A. Thalhamer Co. LICENSE #272303- PHONE: 77 1858 f <br /> INTENDED USE: INDIVIDUAL DOMESTXC'WATER "WELL PUBLIC WATER WELL / / TEST WELL'-/—/ <br /> IRRIGATION/LIVESTOCK/AGRICULTURAL WATER WELL /—/_INDUSTRIAL WATER WELL <br /> CATHODIC PROTECTION WELL /—/ GEOPHYSICAL WELL / / `OTHER <br /> NEW WELL: DISTANCE TO NEAREST: SEPTIC TANK 69 SEWER LINES 69 PIT PRIVY <br /> SEWAGE DISPOSAL-FIELD 69- CESSPOOL SEEPAGE PIT OTHER <br /> REPAIRS: TYPE OF REPAIRS: Drill and case a new six inch well . Install hp <br /> submersible pump for pressure system. <br /> x r <br /> f <br /> S � - <br /> ABANDONMENT/DESTRUCTION: METHOD TO BE USED: <br /> F A f <br /> PLOT PLAN: SHOW ON REVERSE SIDE <br /> t t <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN <br /> ACCORDANCE WITH THE PROVISIONS OF THE LAWS OF THE STATE OF CALIFORNIA, THE ORDINANCES OF THE <br /> COUNTY OF SAN'JOAQUIN, AND THE RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> SIGNED: ,. CONTRACTOR: <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I <br /> 3 <br /> APPLICATION ACCEPTED BY: ,y✓�/�= -�- DATE: <br /> ADDITIONAL COMMENTS: <br /> PHASE II PRASE III FINALE <br /> INSPECTION BY: DATE INSPECTION .. . DATE <br /> E H 1426 1 SAN JOAQUIN- LOCAL HEALTH DISTRICT1/72 1M ' <br /> DISTRIBUTION: WHITE-HEALTH DISTRICT - YELLOW-PROPERTY OWNER- PIN 4 <br /> f <br />