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k � <br /> APPLICATION <br /> SAN JOAQUIN COUNTY PUBLIC nALTS MVIC&9 <br /> NNVIRONKMTAL SRALTB DIVISION <br /> 445 N SAN JOAQUIN, PROLAN (209)488-3420 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> PAR1[IT EXPIRES-1 YRAR FROM DATE _ISSUED <br /> (Complete in Triplicate) <br /> vitcatias is hat tv aade,ta ate Joaquin Cokwtr for a permit to construct and/or install this cork brrele d"eribed. Ihis <br /> 9"eittlee So amdt !a a.A*llYtcc vtth Siam Joaquin CcKu+ty Ordinance No. 549 Wd 3e" aced the a"" am "01"tioaa of stn <br /> aggle N.ouatgr luslQik M flerv3tw. .J W 0�`Ta r» <br /> b A" Ay, Clot Size/Acres[: ' I <br /> VntT'a Hama Address ..,... _._Phoma .. . <br /> oy 7diest� `% ' <br /> C {Cepit No.9302 110"All rt t <br /> MluctaE ,tt s , <br />+PE Tf WELUPUMP: NEW WELL 0 WELL REPLACEMENT n DESTRUCTIUK Cl Cwt or Sere ee yen LI <br /> Itettitaried 1M31 <br /> PUMP INSTALLATION Q SYSTEM REPAM Q OTHER Q D <br /> STANCE TO NEAREST: SEPTIC TANK . SEWER LINES DISPOSAL <br /> FOUNDATION AGRICULTURE WELL. ..r .._ Ot"FA WELL <br /> iuttNm USE Tl PE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATtWtsi <br /> Induainal 4 C)Open Oottorn C Manteca Dia of Vl"Ezcevelli". 015 wma e <br /> R..n ftl rVlUs;. �k j3`6j"Pack 0 Tracy TYoa of Casing EP9dlfoplaiM <br /> Ill Otho I 1 DNta Depth o1 G+ow Sell t - Tyba d �� '# <br /> krr0etkm Approx. Depth I I Eastern Surlac!Seal Inslalsd by P + <br /> Ipair wort,Dona L7 TV"of Pump H.P. stm Werk <br /> W Oaatruetion 0 wo Willow 8ealima Itaterial a Depth <br /> �] <br /> Depth Filler Material a Depth ,k <br /> WE OF SEPTIC WORK: NEW INSTALLATION i I REPAIR/ADDITION TRUCT I 1 aaprl!evnam d wM eereu le d ' <br /> ak}allblr wltltkl or <br /> - <br /> I tlaltlo <br /> an M*8WA: #e �cwW'wlal Eher <br /> k <br /> Nu~of living Ww1v . Nklrnbar Of�oprm j:r <br /> Chmactar of eal to a d . <br /> e .of l,hq: (_,R- Wales table depth <br /> b- , a/Mg t LCalt <br /> EPTIC TANK . e <br /> Ay + <br /> E <br />(0."EATMENT PLT.d 5i111ted of DitpaeM <br /> Dktana to nearest: well Foundation� ...Ptttpntey Lite�.... .. + b- <br />:ACHING LINE 0 No.•Length of firm ' Total WrIgthl ,,? <br /> k w <br /> LTER 8E0 0 Ohtana to nearest. WON foundation Lina <br /> EEPA33E PITS I( ppM Site NuimbMW <br /> LIMPS LI Oisterkce to naaraat: wOlt Foundation _ Prpperty tJlttifR, P. <br /> ISPOSAL PONOS 0 <br /> aareW csnitV that I hew prepared this application and that the work will be dons in HCOrdarte i with Park Joaquin musty mdInvow stale less.and <br /> Las end ragufalbna of the Sian i"Ouln County ip <br /> tanks owner or lkyrtaad agaM a aignstun ezrrihez this following:"I esrtify that In the p+Aerntana of the wok for rtttlrtt tltil panrw N itatla0.f IIItaM Hat <br /> nootr a"ps►aon in ach marwar as to bowffd sublool to workrnan's cornoemafbn Iowa of Callforrtu."Centraetm's hiring a ubteksectife Mgnnws <br /> KtNbe ft folow ftt"I entity that In We performance of the work for which thin penult is iputkd,1 mW ernploy Perm*0900 b wetlNes rt am 10MkY• <br /> in tam of Womft'" <br /> H 1 all ui ins t to drawing on rawna zidO. <br /> ? T p <br /> � • k, <br /> Teile: ..1,rE,..d:.�L <br /> R oEPARTM1NT Uat ONLY * �{ <br /> p9 kation Accepted by Dire <br /> O-cl Arm <br /> z � � <br /> or Grout trispectlon by Data Fled Inepwo"by <br /> Applicant - Returm all copies to: San Joaquin County public Health Services <br /> Environmental Health Permit/Services <br /> 445 N San Joaquin. P O Box 2009. Mo. CA 95201 <br /> F!! A#AOUPiT DVE AMOUNT MMMEO ASN <br /> INFO RlCEIYED eY BATECII PERMIT'NO. c <br /> 4 <br />,t*er.,,..E <br />