Laserfiche WebLink
y;F tr. 4Y.,r w <br /> ° ►.v •.;err � ti T�'f �• ��A=L`� gra � � ir� �.� <br /> ti <br /> r <br /> h � G <br /> r •"' �,,' APPLICATICN FOR PERMIT <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA <br /> Teiephone (209) 466-6781 <br /> q PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Comr'ete in Triplicate) <br /> Appii.ation is heiC:y made to the San Joaptzrn Local Health District for a De•mit to construct andla nstar)the wwk herein described.This <br /> appficefon r:: <br /> mage in compliance wirlr San Joaquin County Ordmence No.549 v,r sewage or No.1862 for well/pvmp and the Rut+rs and Rwulations of the San Joaquin <br /> Local He.lth Distr.ct. <br /> Lot Size - PM <br /> Joh Address <br /> phone <br /> Owner's Name!`-1.u' Address <br /> 0 O) >� Photo 2(i ,l 4 <br /> I Contractor Jj� -_-_ -Address License No <br /> i <br /> PE OF WELL/PUMP: NEW WELL D WELL REPLACEMENT i] DESTRUCTION O <br /> PL MP INSTALLATION ❑ SYSTEM REPAIR O OTHER O <br /> DISTANCE TO NEAREST•: SE?TIC TANK SEWER LINES _—__— DISPOSAL FLD. PROP. LINE ! <br /> FOUNDATION _ ___— AGRICULTURE WELL OTHER WELL PITS/SUMPS 191 <br /> F` INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS i <br /> _ Dia. of We Casir+y <br /> ❑ industrial a Open Bottom CJ fhantacn D a. of Well Excavation <br /> •�a;i Specifications { <br /> ❑ Domestic/Private 0 Gravel Pack 0 Tracy Type of Casing -- <br /> (� <br /> Type of Grout <br /> Public <br /> 1 Other n Delta Depth of Grout Seal _ -_ <br /> I ! Irrigation _Aoprox. Depth I I Eastern Surface Seel Ir.stallod by - <br /> Repair Work Done L] Type of Pimp H.P. State Work Done- - <br /> Weit Destrue,ron ❑ W^li Diameter _ Scaling Matefol(top 501 <br /> iller Material(Below 50') -- ' <br /> Depth = <br /> ---- - 9 L <br /> x <br /> TYPE OF SEPTIC WOpfG: NEW INSTALLATION It.-' HE I I DESTRUCTION I I iNo septic system.perrrwtied d public sewer <br /> avaiUbia within 200 feet.) <br /> Installation will serve: Residence ti Commercial_ th6r <br /> Number of livinc units:� Number of droo.ns_t�.yTft1�- <br /> Character of soR to a death of 3 feet: f�- �14 JJ Water ta5lis depth <br /> SEPTIC TANK O Tyra/Mfg _6- `4_a_ capacity It (A2— No.Ctrnpartmenta 2- <br /> PKG. TREATMENT PLT.O hiethrd f Deposal r. <br /> sY�'i 'pi Distance to nearest: NA oil O I Found,tion_L�-- Property Lite 1 — <br /> s <br /> LEACHING :.INE [`t'No. & Length cf ,inaaTotal length/tsar:_ <br /> pc t <br /> FILTER RED D:s'ance to noa-est: Well�_�!_ Foundation ,0�_ Prnpsr y Line -_ <br /> Number_ <br /> SEEPAGE PITS kY <br /> Depth �y Size �-�—� <br /> SUMPS 0 Distenee to nearest: well � _I Foundation�t� I Property Line�— C <br /> f DISPOSAL PONOS Ll <br /> nd that the wor4 will be done m accordance,wit;^San Joaquin COunzy ord'nws,ancIes^utste taew <br /> I hereby certify t},Lt!hive pxepa+eel It it replication a <br /> 7 >. rubs and re;tutstl:nn of lira San Joaquin Local Her0h OiTtnct. <br /> "r `f Horne ovrwr or Geo:sad cgenf'a siJ^aturz cwti!res the followinc: '•I cbrtif•/that in the perform,&1-.a of the wort for whsch that pxrtr4 b 4stisd,!opal not <br /> omoloy any pEraon ut Such rlonbf a3 to tr^%orae subject to norkman'a compensation laws of Ca:i+unsa Contractof3 hiring Of sub contrscte 9 dpnatu» <br /> �.' <br /> carttins the,tet;owing:"t t art by that'Ir.'t c p9 lormance of the we k for wh°ch this parent is issued,r y.ndll ensploy,persons subject to workmant cOrtpenta• <br /> t..., <br /> ti,)n laws of <br /> Th,,applicant must aC&III for 1 requlrad irs actions.Cornpleta dishing verse side. <br /> =:fined X r v _ Title: - Data: - - <br /> -t r. <br /> �,�� FOR DEPARTMENT USE ONLY '7 <br /> t . O,pplirstion AcceptoJ by^�_�_i sem__ �f�� I/ — Data�L.�=r A.1-=--� ��/��, <br /> /}� hat, - nal Inspnrtonby J" <br /> ppr C>rout Impaction t <br /> y <br /> 11Add!1onetComments: d Tom. •-- '--� --.�� �-_ .2_ _ST�-Lt_ <br /> S'L 4t3WO O LoJi 3fi9 3L 11 C Manteca &?3;[Pi O Twit b3S13165 `. <br /> Apcl;eBM Rt:ttl+ir tri copies to: Envwronrnentel HcsIth Perritt/Services 1601 E. i rekin Ave., P.O. 8_x 7ciY3, Sti„ CA:?5201 Fj <br /> �Q <br /> r2E I AiAptiN1"DUE AhiOONT PE*.'"fED ^V � RECEIVED B'{ DATE Pf0.HR VO. 1 <br /> .fN 11h 111h.Irrar , L �-� �- k3--3�0 � •d. <br /> en tats --- <br /> -,4'7FL� y'vr'�..n �'"1Ar�:MA't"KI/s-w+R•N`..'r.....w.,.wrw.r.:n..?.in'rgb1:��Q13RJRiY.Y]lAl1Ja.;.\t�'.�J-II r.Xy.�,, ''\ <br /> .w.r•r.,,'wcM.\Vs^AM.'•d40V.filr?t1.1b5tn. '^.�� <br /> A. <br /> ti <br />