Laserfiche WebLink
17�-.+ 11' 1G1'1i i.ui <br /> I u iJit:i.�i cJc�r; r.uc <br /> }� APPLICATION FOR PERMIT <br /> SAN JOA U Q IN COMM PUBLIC $8ALT8 SBBDI l� <br /> 445 MVIROMENIVISION <br /> SAN J ZK p�g (209)468-3420 <br /> P O BOX 2009, STOCK <br /> �, CA 85201MAR FROM SEP O <br /> 2 7 1993 <br /> LAW DATE ISS <br /> L (Complete in Triplicate) PF0NME ENTAL�u.tuen i i. aad.>s 9cde to Bat► Joaquin County !or a yers►is to eoostruet and/or Ina SIT/SV// yEgCTy <br /> awlica cents Atbiio >?�liaaee with Ota Joaquin County Ordinaaes Ifo. SL9 and 1W sad the vori berei�Qsorlbed. This <br /> / eorwieea. Jtules and Aefulatlaw or San <br /> Job Address /l0 y7 A�0 : <br /> -- City— Lot Size/Aeretfe / AG <br /> Owner's NanaL � �O g0/ *,"Radv) 10*d <br /> Address 6L 9S73 O "we <br /> Conuacta :.� Address&&a(, iRi0 37 �� 707 <br /> TYPE OF WELL/PUMP: NEW WELL O . License Ns. -. <br /> WELL REPLACEMENT n DESTRUCTION 0 Out or verviee Yell Cl <br /> PUMP INSTALLATION O SYSTEM REPAIR p OTMER §f isorita sled <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES ��/ OI'i-V S O <br /> ._._.�._ DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL ,..__ OTHER WELL. PITS/SUMPS „ <br /> INTENDED USE TYPE Of WILL PROBLEM AR' CONSTRUCTION SPECIFICATIONS <br /> 0 Industrial O Open®01101" O Manteca Dia.of wwemlation <br /> ri 00"018116/Private O Gravel Pack O Tracy T Die.of Way Casing �J <br /> YPe of Casing__/7 b n Specifications ; <br /> III Prablic Tl Otlw n Dots Depth of Grout Ssat Type of CA C <br /> t,Irroatim —AW"r Depth 1.1 Eastern Stufaa Sew installed by --- <br /> RepN►work Done E3 , Type of Pump M.P. State Work Dane <br /> well cmwwtwn O WN Dirnetsr socias fbtszial i Do" ell1wrriC.. <br /> Depth "lies haters" i Dsyth <br /> TYPE 3F SEPTIC;;mkc NEW INSTALLATION I l REPAIR/ADDITION I I DESTRUCTION i I two septic ayst.nt taaraetted A pubic sewer <br /> snailawe within ZOO test.{ <br /> InstaUrion wo am: :Raider"_ CottwwCwI_. Other <br /> Noir w of wiry units: Nuwbw of 61d1tt>rt10 <br /> ch reew of sell to a/ep1R of 3 feet: water table depth <br /> SEPTIC TANK. O Type/Mfg Cape Ne.Cor"potr"enlb <br /> fMCG. TREATMENT PLT.O Method of Disposal <br /> Distance to nearm:' WON Foundation Property Line <br /> LCACHWG LINE L1 NO. a Letgth of bw Total length/sloe <br /> FILTER OED O Distance to nearest:, way Foundation <br /> --._� PropntY tine <br /> SEEPA06 PITS I I Depth Site Nurnbw <br /> SUMPS Ll Distance to nano: Way Foundation — <br /> DISPOSAL PONDS O Proms~Line 1 <br /> 1 hnebY oerofY that 1 have prepared this apple mion and haat Ina woo*wig be done in accordance with San Joaquin county a0insnces, state Awa. note(, <br /> ruies and foomk we of tis San Jobouin Cv-1w v <br /> Morris omvw or Reetwd egnrl'e iignsture COMM"the 1elowGngis fa <br /> : -1 eerft that in tis of the work for which this peetait is issued, <br /> 6 compensation Uwe of Catlforrris."Contractors hiring or subt ahlsy nrot� <br /> thason in assns nw+ner M W OeConne subject so worknaae►' <br /> lion Awa o1 Cow".-IONWtfnat N eta peApnrasnce N tiso <br /> wk for wa+ieh this perMt is.lssued. cartnetitq a:ynett <br /> o161W1 eat+pieY persons subject to wl"In0nl eom"nes- <br /> The applkant w4m cis for as repair inswtiora.Conviete dnwkv onreverse <br /> ,,side. <br /> Stprad �� <br /> Title: vGr wry, Date: g <br /> FOR DEPARTMENT UBE ONLY <br /> Aopkadon Accepted by -g" -Y�W-4 Date b AreaL v P <br /> Pit or Grout h peoeksn by kka,,og Date P i <br /> 0 � FkW Inspection by !� 1K • Date <br /> Aoalioral coaar ares: '2- A (119 <br /> Applicant - 20tura all copies to: Sea Jt>•gala Counts Public,itealt:h Seawieea <br /> Ita►iroadeatal Neaitb Permit/Serrieee <br /> 44s N Sias Joaquin, P O Sm 2009, atka. 04 OU01 <br /> FEE AMOUNT tltiE AM <br /> INFO OtMfT RfAahTTED M RECEtVEO aY DATE ►E1tkAlT'/fC. �� <br /> sat>�IaN.�i•t,r ��� �� <br /> 2.4 <br />