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' GAH & UP Fax:925-123-4562 Jul 29 2013.02 1pm P002 E �
<br /> I=V ;SAN ,, . 'i�a. =. cQwn kow a 15 00r
<br /> la:MMTH J31. is
<br /> 445 X SAN.JQA10;i]1N�: P ON .U ) 6s-,3420 ' '
<br /> ,gyp 3
<br /> P d 116X goo, ST0 0�, Cg 95261Aft-PROM bAn-l"s P-1
<br /> ApPlieation in hd'keby "da bd gam Joapuii Couirty roi. a p6rmit %0 eodatrupt titt.9/or install tho Work berain aeaarlbed. Thio
<br /> Zvlicat:ian to=40-4 It d0b6.idzlee'vith San J400ih Cduaty DIrdLAWIce No, 5119 and ).%2 and rho Rulea "i Regulationo or 9uq
<br /> ,Toaquin county Public NgaLth UYvic lo,
<br /> { Jab Address V City G„ Lot Size/Acreage
<br /> 7u
<br /> Owner's Nama _ Add�$ss � Phono
<br /> CanlrAcior �raQdioss_ ep5a too. QEt�. � Phbn4.
<br /> TYPE OF WEL /PUMP: NEVV WELL W !.t FiEPLgG1;A EN D 57RU Ti4 O out or Se rico'weir
<br /> RUMP INSFAL'U Q S TEIM A04,I9 0Tti�ai C1 Monito/sing Well L7
<br /> DISTANCE TO NtiAREST: SEPTIC TANK —_ SflWOR LINES ., _ DISPOSAL FL� PA4P, LINO-
<br /> pOL1lVAATION �;�„_ AGA)tQ.TVR9WELL �,.�,..,. oYHEFI IN��_ PITW/ UMP8
<br /> INTENDED US8 TYK DF WeLL k6bLI M AAAA d0fa- 3UCTI N 90EClP1CA710NS �f
<br /> Q Induotnal Q�0p06 sonorn 0 Manteca Dlo. of Wait Exebvdtiort_, Ois. of Wall Ctsol
<br /> ,A,6omesu0Pr1vala Grpvel Pack• Trdcy TYPO: of Casing SpeeHldptions
<br /> I'1 Alltsgc t7thar' L7aIra dapili 01 diout Sgal T ' P of Grout
<br /> 1 I trriUal:on � p Appiax, [iapth, I I eobtorn $urtaco 9eui Irisrarlad by ta/
<br /> Rooalf Work Aano Q Type of k6fp H,P,, 15lato Work Dario_
<br /> Won betstrucllon q W9I1 piaritoio'r �� ' daa].titg Hr►torial � aJcl?t1} . . '
<br /> Depth . F'il1e� idniiri•ittl. L Ijapbh '
<br /> TYPE QF SEP 1C DI;IC: Nf:W IN$TALLJiT14N t REPAIR/ADLlITiON I I .OES7RU T101V I i INo 5aptia ay5tarsti parrititlad i{ pt�Dlie sower 1s
<br /> _ oveilabls wilhln 200 feat.a
<br /> allsNwl wilt servo: Iia:kidonca,;.,..., Commercial_..,_ 0{her; ,^�
<br /> bar of ftYlnb unito• '' Ntirtihoi of bodsoorhs
<br /> Itiraatur RI son to I Copia'of 3 loot: : Wafer table doprh
<br /> SEPTIC TANK 0 Type/Mfg' Cappgltlj _ No. Currtportrtlortla I
<br /> PK6. TpIATMEHT PLT.Q Mothod of Disposal ,
<br /> 01Stor%ca to h6araatf" Well Fct.widarlon Property Lina
<br /> LEACHWO LINE 0 No. b'Lanath 6f Iltyas Totat Ion@th/size
<br /> FILTEA BED
<br /> ClQ Q15tance t4 ndtiroat[ Well Foundation _ Piap**rty L1ri4
<br /> SEEPAGE PITS ! 1 'Daptti $ito Numdar
<br /> 5lJhla'8 RI Dletarica to Amami, Web Foi,ndatian Propeny.linre
<br /> DISPOSAL PONDS L7
<br /> a haroby comify that I IAVa proDSred thlt appllcmion and thaS Irrb work wrli Iia dono+fn accordanoo with San i6dquin county ordinancos, slato laws, and
<br /> rules and regulauons of the 680 Joaquin Counter
<br /> Homo bwhar or Ikensad atjclit'a slgrtbture cartlflas'lh.0 ralldwing:"I,cattily Ihat'in thb Iwr}arrnance of 1110 work for which this porrnll Is bnued, 1 shflll not
<br /> employ any porton in such marinerop.'ta bocciha au*ict Io'wgrXfhon'S aortrobnsation laws of CallforWo."Contrahtor's hl rang or sub-cinntrae4ng sIgnituro
<br /> aortrf4l'the following,,,[criniN shot in lh4 WJ51'r114n01 6f fhd work for Which thls pdrmat is lauuod, eq s
<br /> I eh 'dt io
<br /> tion laws of Caplarnla." G Y Po}aart'a auhje�gi to wnrkr�►dn's'acrnygn9a-'
<br /> Tho applicant lL7uit call lar all Mqulrod inipotlionp, Cainplote drawing on r'vorob ride.
<br /> Slgnod X ?i[10, ' 3 p r
<br /> Data:
<br /> Pdai DEPARTM4W,USE ONLY
<br /> Appllsellon Aoospto$by Otta -a3'ga— Amb C211t-01
<br /> YA or Drout lnspectaon by DaW Final Inapoetlah by
<br /> < —nal Cornrnonla: ,
<br /> IpPlioant keyvrn all "0108 101 'Ban loar4uiu County PubXiv Il0A01 Sosvioe4
<br /> Savirohaaulztl it®alth Parmit/56"Acclam
<br /> 446 N 0&n ,loayuitt, P o Sox 2009, RULn, CA 06201
<br /> INFO A8+{a7UNT ptJ gMq.uNs>iaf;,i�-r6o CA6H REC91V90 ny DATE YrtAMFT'NO.
<br /> N I124 IpEv,kiRni
<br /> Received Time Jul. 29. 2013 2: 07PM No. 3701
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