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E <br /> s <br /> i{. <br /> t f <br /> APPLICATION FOR PERMIT <br /> SAN JOAOUIIf cK)UM PMIC HEALTV SERVICES <br /> EMIRONIUITAL HSA'rT8 DIVISION <br /> P O BM 2009. BTOCKUM r CA 95201 <br /> (209) 4$8-3447 <br /> (Complete in TriplICILte) <br /> _ F • <br /> Applltatlee 1s hereby Mae to Ban Joaquin County for a yir�it to eonotxaet ttwar tslatall Ileo►tool! haroiP �ttees of son <br /> applica%tea la vada in empllanao with sae JM44!r Conmty ordleaece Ib. 9 sed lA6!aM 48s!!alas deed <br /> Jo"uln Couwr Publle Raalth servLeos. k <br /> _Citn tet StulAceMis <br /> i <br /> p 9 �^ P <br /> ,fob Add so <br /> Owr+tar a Nana `� , Al <br /> Atidrala .� Pow, <br /> Conttaclor Addres6�5 tw <br /> Lkenie Na <br /> W .S�L7�M1tolta <br /> s YYY� E WELL/PUMP: NEW WELL C f WELL REPLACEMENT D85TR10EM7OTHER t Of va <br /> SYSTEM REPAIR C7 OTHER Q <br /> NpeltsOt'1eS tb11 (] <br /> RUM}INSTALLATION � POOP.LINE <br /> DISTANCIE_TO NEAREST: SEPTIC TANK y0a-_ SEYYER LINES � DISPOSAL FLD- <br /> f01JNOATION _ AGMULTURE WELL -- OTHER WELL d MTS/SUMPS <br /> 1 4 <br /> INTENDED USE TrPE Of WELL <br /> PROBLEM AREA CONSTRUCTION SPECIFICATIONS �, Y <br /> O open so"" O Manteca DN.of Wall ftteewatiort OIa-d Well:Cetdnp <br /> E Cllndwabial �aCtlKasiOtta. - <br /> �rrteetieJlrriwete f!K Orad Petdt' Q Tram Trpr of <br /> A►nolle 1'!Other O Delta V.-•'of Oreut Seal T"w of <br /> s <br /> A— <br /> ri Irrrwlph —A004e,OW�h'� �3_609 n SuAice Swl u�sat�d hr <br /> i Repair WSA Dona U Tv"of PwnI, a�+rs.a^ M.P. . S Were <br /> Wall O@Wu tlah OC Well Dwn.b. 1°K w.ar1.1 a Deytb <br /> t Deptha' _ P111ar ahtar[al a Depth <br /> Y a► WO <br /> T RK: NEW INSTALLATION REPAIR►ADDITION Cl DESTRIftTION N0==N fW J off e is e� s <br /> w6aftNah will wwM: holder— Corwlwdm-- Otfnar --- 4 <br /> Nwnba of"VMS: Nuff4w of bodr0011 <br /> . Character of[oll to a dWh of i fen: NIL C ober FlIefft <br /> t <br /> SEPTIC TANK Ll TypaJtlMO c000thr...._ Ne.Co 01 Dispo <br /> • PKV.TRflAT1aENT PLT.C1 ���Dlspeuf it <br /> tfoundation . � Proponv Linc <br /> Dianna Io nearaet: Well <br /> LEACHINO LINE C1 No.A Lenflth of linea Total ianpthleira <br /> FILTER SED LI Distance to new": Wer pav"dar'on PFomw 0- <br /> SEEPAGE PITS I i Depth .--.-sin Nurnlwr o0arti Line � <br /> swaps LI OWNIfte to tw OO: WON Fowndel-an <br /> DISPOSAL PONDS 0w• <br /> t I N"w CarflfY that t he"pttlperod thb applK <br /> atton and that the wwk wdl be done;n recot"with;.an Joeowin counter OrdwWw te.dab►awe. , <br /> rube and necu etione of the San Joe4wa► eomw <br /> f Roth[Owrtat er aeenard apartYa alpnetw»oww*s the 10d0wrng:"1 eereitr that in the pe.•+errnant:e of tho war for wwh"PORA is awned.1 ww not <br /> erg" aw few',h rw:fr PtwrnN M b Oeean+e ewbpet te wgtrnan's epmpeneetioh Iowa 01 CNtfcnde."Cont►actofs hwina or!ob-"ntriOtinp alWWWO <br /> t:afSlriaa teN i�aewMtO:"1!►Miter that in the Pareorntonee of the worA for which this Perndt it iwued.I she!enwtor COW wbtscs b wptrtlan'e tCOtnpatnea- <br /> tion taws of CelhoC+te <br /> i The appaeant m t go tot aired insWetbna•ContpNte drawing on Side. <br /> Slptwd TitN: Date: -7- <br /> r <br /> R D ARTMemy use ONLY <br /> APPfkalieh Aceapted btr Date t •. <br /> Nt or hlepettbn by Den <br /> Fine!Irtspeetien DY Deta <br /> Addlvlonl ComprMMill: dM4 <br /> 01 <br /> 12 W� f <br /> Ayplieeet - ROILY" aii eeptn sot SAN JOAQUIN OOWTV PUYLIC KRAL" aldlrlCta <br /> [01YIRCaIyt]t'!AL NlALtill D1WLa10M Paa,Ylt/SaltWlC� gsa01 <br /> 445 N SAN dOAQUIN. P O 8071 2000STIICIITOR. <br /> AIttOUNAen <br /> Ir Ott! /tMOVMf NIMtTT[0 ►4CltW a+r.. 04'rg ►eaMtl uf0. <br /> 1[[ i <br /> r»te•rt�4M.�eaO��'� rel .� �F? T94 <br />