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<br /> IE miar iri'campisnea�w`N+SanrJaaiIrm t'.aunty diis A Na`r5q 40:psi epc ai!w 4586 iya�ii► and nis ltidnlnd Rpul�ioi►s c!Siem "
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<br /> TYPE CLF WiLL1PUMP +� PI WELL,CI �� WELL'REPLACfMENI �' x `PESTAUCTiOH r ry r- r
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<br /> '� ' FIST ONCE SU NEAREST ,SEPTIC TAN0' LM�Q,5E411ER lItVES'��, µz�`"�ISPOSAL PL��PRQP.E INE�� r �� y
<br /> „*r ��t� ��(��r5�f'�,it � =EfiOWNUATION�'� '-�AGRICULTWRE WEl4OTHER IYELL L.i�lC:_�PP_TSISUMI'5?a=� - s T t,�
<br /> ..0 ED USE J
<br /> ��4T•PE OF WELL"" 'PR08LEM AREAr CONSTRWGTION
<br /> INTENDSPECfFICA*10NS�_ ti � p 4 r,� }
<br /> (1 ratnsl, �. U Openot > fid Mmlace '?�r Diarof WaN ExcavatJan
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<br /> r tngaitoet ra„=t)epthl l Eistem #�y.SurlaCa ser InstaEa
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<br /> TYPE OF SEP'IC WORK.NEI&INSTALLATION I 1 REPAIR/ADI)tTION I,I t DESTRUCTION l 1 INa septic system permuted H Pudic sawei fs '� ;,r Mks' dk
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<br /> Ci �1 Y.'w P { r
<br /> <f _ 1 Hunber ofi6vir><►yuMs Number of bedrooms" 1_ , � t Y
<br /> YaY�Chaiacter at sea to#depth Ot 3(@et _ f ;" �. ' '�1_.Ware tahk depth ' j S y °.t a' }a, Y_ y~, R
<br /> i "4- .,i. "< -,s 1f y"u yey#J t!^ Ic..K h-ri .�sr. �s„ , a"SB'� +: h �' yc a
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<br /> SEPTIC TANK + O Type/Mfg CSG rCnsY, yNo`Coenpxtrl>ent:�`" } r a �� `�l i�a 1�0r:€4 raj � y
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<br /> �+FKG TREATMENT PLT Q . _ a .� ;�-�-� +, Islethod a'
<br /> " rY °4tN yl , ` w. r,;.�•r - - S e rt+ J -J �.1 i ra^' Y's, rp �m<'2 a x x '°'' r 1w j`,,,
<br /> ? J nstarvice to nearest well " Foundation` Property Lina y7'y r ry Kw' 4y °'{ya��YF
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<br /> a ❑ `No Lerpth of as* ALINE
<br /> Tote?)eVhlsjze ',j s kers r ,a r
<br /> FILTER BEP R Otstanca to rsea est We11 a FoundatiWoper
<br /> on ry Line _•• t
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<br /> 1-1S —Sim- EEPAGE PITS I I Depth Sim Number
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<br /> tIsumps Il Distance to nearest We11 Foundalgn Property Lme s � i „ 'r Y
<br /> DISPOSAL PONDS .Q
<br /> I Naseby certtFy that i Nmx prepared this applrta[ion and that the work oval!be done in accordance vnlh San Joaquerl[Ai+ntY OrrYateriCea stats law; Jird.�r r 7t;iVi i''ji,Ly e
<br /> .IOaglnll F r i ' s ai a '-, r i t :' ..✓.•�^* ,w;�c} 2 �. Yy,fe3 s VW,
<br /> �� r� w^ rukf and tegulaImne 01 t`u San Local He
<br /> t33rsxi * p- , r 7 '- I �c5 ya' p wT
<br /> w 13#y_SFr r Horne,owner ar licensed agent s signature oerLties the loriowirrg l oertJfy that m the peArirmand of the work fa wsriehifiu parrot is tstaJad;l Iasi «
<br /> �= t`mdnrploy any person In such rnanner as to become sublect to woririnan a eanpensauon taws of Caliloi w,Corivaciaes hwttrgor wbrOnttaCteag pgrlature�
<br /> •urr^ tet;'*� Fx`�°.t C 1 isi t!w lopowmg I earufy that+n the pasiamwncs o!the work Oar which ttus Parrot m sssuad !shall ampbY Vawdu tsubptt to tMorkman s campaew
<br /> `d bon laws of C Blains- t �ftir ._ tom• + x, sr r� ' 2yw-S w!c+ ;t� 3yC-
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<br /> Z.Q. FOR DEPAkIEIYT USE ONLY
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