|
APGL-.:ATrCN F-jrq PERMIT
<br />Li -)CAL
<br />i601 L. I !A?tL-'% AU., S70CF.TOH, -A rE;ff:T 14r.):
<br />Tp.er.none (209,1 466-61�1
<br />PERMIT EXP(k;S I YEAi FROM GATE ISSU-b
<br />(;ompletc 4• [rip—cats)
<br />App licatior is hereby trade to the San'joaqiir Ictal Healtni Sistrict for a permit TO C0,1.t,uQt d0d!(jr install the kr-k herein
<br />described. This applizatio,
<br />is ra.',e in compliance with San Joaquin Crunty
<br />Ordinance N., 549 fDr
<br />sewage or No. 1862 for.w0l/Zu1T%:
<br />and t --^.e Rules and 4egulatio,�s
<br />of trie San Jodrj.Aa Local 1ca' th 'DistriCC.
<br />Man teca Dia. 'Zf7-ldell -Eitcavation-
<br />uU Ado,Ess A�
<br />Su->diviSiD?' Name
<br />E -j Tracy Dia. of Well Cas"nq
<br />Pubis
<br />DwiLr's Nary- :5'7k: -W'4
<br /><&'it D Address 16 012
<br />t1>
<br />Aoprox.
<br />CbntrdCt0r'S Name '4, L
<br />141u.
<br />pt" — of Grout Seal
<br />Phcr'.2
<br />TYPE OF WELL/PLMP ',13PK;
<br />NEW W -E LL WE:L REPLACEMENT
<br />DEST;JCT]04
<br />,urfat:4 Seal Irstallee by
<br />FUMP
<br />rNSIALL-11C'A SYST-'-w REPAIR U
<br />OTHsk
<br />Well ne's'U'liction
<br />-1 Diameter
<br />-SFWE�-LIHFS
<br />fLn,
<br />PROD, •-LI N E
<br />LEACHnc, uplt jJ 110, & Length of fires J Id y rCCji'.e;qTh/size
<br />X
<br />-rLTER BEDa t ion, 410 F, Pronn.rty �inr
<br />Uistan,,:t to nearest: 'reel',.
<br />e 1 oq�-,
<br />SEEPAGE PITS Depth Si"P Num:mr
<br />'Sump5 Lj Dittance to nearest;
<br />earest: We I rouniation rrop>rty Line
<br />I herety ..erti fy that .-Ilha /r prerArM this
<br />s appl fca' ien jol, tha: the +ork will be done in •jccord3nre with San ;naqUiri county
<br />ordinances, !siate laws, and rules and rei;ulaticns cf the San -7oaquin _tical Health District.
<br />Name ow -ler arjicensee,-3-je,;L's slonature Certifies the�follorwing: "I certify that in tre perfinryarict tt` the wo-k for which this
<br />-,ermlt is 1ss.ed, : shall not cfrpfay any person in siAlt manner as tu-becomc-�su.)ject to w;,rk"n; coitpensat"Ort laws o� :alif'nrnia.'
<br />Cortractor's hiring or sup-rontract**ng sigrature certifies the rcllow*nq! 'I ccrtiry tr,tit in the. perfarrvjct! Of tnp work for which
<br />this p-ii0tiis issued, 1 shall employ persons sut:jict to workm3n's compensation laws o.1 '.alifornia,"
<br />the appl Icent gust C/l. lar 11 re red Inspections. Cotplote drawing on reverse side.
<br />St-ined X . Title Date:
<br />1`310%ill"MELT USE ONLY
<br />� k,
<br />,ApFlication AccectLd by Area .466-57Z!
<br />!,dditional C-4ritents:Lodi
<br />Pit or Crait Inspection 823-71m
<br />-C Dae
<br />Tracy 8 5-10A',
<br />.inal I-spoctiun by
<br />kppl icaril, ReCurn all copies to; j�vironr;pn31 P-2-N-it./Services 1501 !Iazel-,On Ave., 1.0. flux 200P, I St
<br />CU.- AMOUNT P.EvI-TEC -'CCE!VED BY D4TF 7 -r=14.14 -1T N.1.
<br />CL';Z;'
<br />Ell 13-24 REV. 10/82
<br />14-23
<br />-.0
<br />FOVIDATION
<br />AGF:.ULTLPE 'WELL O --ER W;LL PITSJSUM�S '>
<br />INTENDEa JSE
<br />Ti-E_3F MEL_
<br />F;02LEM AREA UNSTRUCTION SPECIFIZATIONS
<br />Man teca Dia. 'Zf7-ldell -Eitcavation-
<br />Gotoes t. I c / P r 1 va t9
<br />� Gravel rack
<br />E -j Tracy Dia. of Well Cas"nq
<br />Pubis
<br />'
<br />r,-h,,
<br />[J- Delta
<br />y*pe or Casing
<br />rrilation
<br />Aoprox.
<br />E] ftstern
<br />�P% if cations
<br />Ca Lnod c Protection DepthDe
<br />pt" — of Grout Seal
<br />Geophysical
<br />Type, of Croat
<br />10ther
<br />,urfat:4 Seal Irstallee by
<br />0,2pair Work Dome
<br />Type of Pimp
<br />rH. P, -�tatr- '.+.)rk Done
<br />Well ne's'U'liction
<br />-1 Diameter
<br />-5eqlfng 'rwtyrial (top bo
<br />Depth
<br />Filler X.Aterial Ae'Tow 50'
<br />TYPL or SEPTIC WORK:
<br />NEW I14STAL A;:01K
<br />',`RbA',R/ACCJrIQh-.D (Nki s4ptic-tart< or see.ige pit permittod if public st'-'er is
<br />J'. % ..
<br />Residence
<br />available within 200 fpet,!
<br />lr.ctallation ill
<br />serve: jel.
<br />Commercial Cther
<br />A
<br />Number of living units: Number of bedrooms -ot size Ael,
<br />Character of soil
<br />to a depth of 3 fact:
<br />ALI bkl 'dater table de-.th 91
<br />s:PTIC T08
<br />Type/Mfg
<br />Cdpdt it.Y IAWV - - No. CompartmL nts 41
<br />PKG. TREATMENT %T.
<br />Type/vfq
<br />V*Lhod of Dismal
<br />capacity
<br />SEWAG: SV�TEX
<br />' ' r -
<br />nistance te) nearest:- vell 4e' 6 Foundation . tgfi Property Line
<br />12 v
<br />0476-17':'014
<br />LEACHnc, uplt jJ 110, & Length of fires J Id y rCCji'.e;qTh/size
<br />X
<br />-rLTER BEDa t ion, 410 F, Pronn.rty �inr
<br />Uistan,,:t to nearest: 'reel',.
<br />e 1 oq�-,
<br />SEEPAGE PITS Depth Si"P Num:mr
<br />'Sump5 Lj Dittance to nearest;
<br />earest: We I rouniation rrop>rty Line
<br />I herety ..erti fy that .-Ilha /r prerArM this
<br />s appl fca' ien jol, tha: the +ork will be done in •jccord3nre with San ;naqUiri county
<br />ordinances, !siate laws, and rules and rei;ulaticns cf the San -7oaquin _tical Health District.
<br />Name ow -ler arjicensee,-3-je,;L's slonature Certifies the�follorwing: "I certify that in tre perfinryarict tt` the wo-k for which this
<br />-,ermlt is 1ss.ed, : shall not cfrpfay any person in siAlt manner as tu-becomc-�su.)ject to w;,rk"n; coitpensat"Ort laws o� :alif'nrnia.'
<br />Cortractor's hiring or sup-rontract**ng sigrature certifies the rcllow*nq! 'I ccrtiry tr,tit in the. perfarrvjct! Of tnp work for which
<br />this p-ii0tiis issued, 1 shall employ persons sut:jict to workm3n's compensation laws o.1 '.alifornia,"
<br />the appl Icent gust C/l. lar 11 re red Inspections. Cotplote drawing on reverse side.
<br />St-ined X . Title Date:
<br />1`310%ill"MELT USE ONLY
<br />� k,
<br />,ApFlication AccectLd by Area .466-57Z!
<br />!,dditional C-4ritents:Lodi
<br />Pit or Crait Inspection 823-71m
<br />-C Dae
<br />Tracy 8 5-10A',
<br />.inal I-spoctiun by
<br />kppl icaril, ReCurn all copies to; j�vironr;pn31 P-2-N-it./Services 1501 !Iazel-,On Ave., 1.0. flux 200P, I St
<br />CU.- AMOUNT P.EvI-TEC -'CCE!VED BY D4TF 7 -r=14.14 -1T N.1.
<br />CL';Z;'
<br />Ell 13-24 REV. 10/82
<br />14-23
<br />-.0
<br />
|