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APPLIPATION 1001 PEWT <br /> SAH JOAQUIN COCifty Am1ll0 AgAt,'1'S..15BIt' 1098 <br /> :DIVISION <br /> 1601 19"1 HA BI,TOi!1 'AVB.�y 1tx b tr (209)488-5420 <br /> g 0 BOS 2068 j ;S TIP y";CA .06901 <br /> r.. <br /> (.complo a ill ,' 7 iirlia to}. <br /> i <br /> r� it hereby Chases,to t3ilu J064ttitt Count�i tor'd ermi <br /> ppiication 't #iii-dt5rlathWt tibia/nr inetaii the vara herein described: This <br /> made iia cosi ii+turte pithJ in CoubtT Drai a lire 54 and i$GQ find the Ruses and Regulations of San <br /> Joaq�iin Cougty Public Lieaith ft"Iees. <br /> '��� <br /> ti�l3i`f'te of Bit t�_ 5 <br /> Job Addrrt:s -. Ll1� .� -_ �, pity TJrlkey <br /> Ownsed Name Teiehert A !psi s Address '.1'' Qtr x Phone <br /> Ctliwh )i` <br /> e. <br /> Corilrscltu �_ LA PP <br /> A ,_��. _ Lice ae No. ` dal <br /> TYPE OF WELtJPL1fKt' fU€yV Et L WELL.qf< kAC6 EN F fw1' 'qE$T IJC I N t of Ber�rittt Heil' 'O <br /> ' tt� <br /> � Qw <br /> DISTANCE TO NEARtl3T 5EP7i TA 1K yw LrWgft LlNE9 " 00 C .„. � PRO IRR ” <br /> INTENDEd USE TYPE OF WELL ;` C1 4 Aft t t:E3f+lt 1` Y €�N St�E <br /> �� { <br /> n Industrial 0;CJpe(t 'x bolt:Sf tf 'Eilcrti .rI i5ie, ofWe <br /> � dtfR <br /> (-I DorstI6IPtIvAid, C a;terral Pack: c#ta�y. ' <br /> ne $pMciHe�itltltiaxs <br /> l ► Publir t"1. ittiaf "f f t$eltg" F tetrlSii SSbI < TypS of##rtliri "; <br /> t;! Irrlpalian Approrr..'tiaprh1'-'t i` Ahern F a ski. l;inetrlititf b " <br /> Repast Wotk babe 0 ,ter <br /> Wall bastructbh tllrlE bili tali 8aailtrd M�tlt`#a3'IwV Cad tau <br /> bgpth � lriUtlf <br /> TYPE OF SEPTIC WORK NEW 14STALL.ATiON1 REPAIRIADDITION.A.}� r 7 iJCTtO t b ptic s ort rrriltted it pallid WWor it t <br /> t ;�Vsllablil aorta >t�etlt,l <br /> Installation will tfblwi:' �lelidErl�lr Carlrleti�fel <br /> Nuft*w dt Woo unite, _ Zrntter of blldfeo+Yii r (` <br /> character of"ll to i depth of a fbaii x : VVita"r table,dipttt <br /> SEPTIC TANK-- <br /> PKG. <br /> ANKS d TypblMfq � ip.clty F ��� Ndr t ofmpirtrtlsYita � �k <br /> PKd: TREATMENT PLT,Ca r M6thbd of 01fookil <br /> pistirt4 to"as"tt"p Wdq 6 3i,11 p t .� t itw.lidl �F <br /> y. <br /> LEACHING LING Ct 1Vti:. 61spg � +z ywki' ;Milt tiflSiti tf(#d <br /> FILTER BEC! �c �q t 1u,q <br /> ..:© Di ttafi a.16.�htlaftliti- s Vdsll <br /> { <br /> 4w <br /> SEEPAGE PITS, "I'I . ilegth ''' tat ra � i<litti,l!!t <br /> SUMPS <br /> . .Lf via saw tel kilataet :' Wall <br /> DISPOSAL PONDS—. <br /> 11 <br /> I heteby ettilfy thb't I flim 0140Trm Im rules and �ppiicet I ar,�`ihrrt lits Wdrk Hni[ in$L $Fi;fiii$it rlaiil '�d�9`i3ffE uir7 4uiwfy,tYrdineff 'btaid.Cbtlt . saris <br /> Horns ownar of Ilicsnsed bgerit'l tiprtstil4 Mhat tfis twowlrtg 'I cmdv trait iii the b'erform6mot btYthi Work lost which thio ' <br /> g q t,1►', <br /> petrhit is IaSubA,t#bee not <br /> etMOOy any pdridn In Stich t7'tanhsl is to buabft 6ubl dt td Waikinen i coOipitAMI1dA ISM bf:Ciatif+otnia. Conttactor'a hiring bt sub-tttnftecting signature <br /> cartifieS the loslymN:"I certify thot tri thi pnfatrtl n a of thb work ttlr whlctl;tAtr piftwt ie Iseiisd,f shall ittiptay o it/ont subject to worklMws ctmipanla- <br /> tion taw&of t"fathia.'• <br /> The applir ertt inn$t"It for all raqujM inallktiun Complete drdwing on.tMiierii'Sldb <br /> �r =a <br /> Signed tt' d dant 4�-17-91 <br /> Tfeie .,. .:� ., - ... . ,._ bate, <br /> EPAMtMINt Ut t>fNiY+ <br /> 491 <br /> Applicetten AlrCAptbif by {3aid Aril <br /> Pit or trout thopkilon by �#iaiA F� irtiliti es leis <br /> Additional Com"id <br /> Applitant Ra�turn y o = s <br /> Ser.teer; ' sritotuiieatei kdlLitli�lrtatmtltis"ider <br /> itst7l x"ma"Itau 11vd�t $ Cl' 1:$toclAdd r CA '05201 l <br /> r. <br /> IfVFCI AMOUNT DUE AMOUNT AWITTEtI WE.�{ PkllMIT,Nd. <br /> . EH I3-21 ENtN.rlRsl <br /> EH tam t' S 1 9A f <br />