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17 <br /> days+lt- 3AI C)' `JIN. U I'+ ALTH SF- {1 <br /> iltb�fA ';{ A ,T b IVIS IOT <br /> "449-M-190, JOAQWX� PITOM (21166)469=3420 <br /> P o box 2000 - stocktom;, CA 95201 <br /> PER1d T IRKS I 1 19AR,:FR M DiTE 19jSUED <br /> (Complete ,in TriPlicatIe) <br /> Applicitiori is h6reby llhe4e tb Sm JcAquip County for a permit to construct An,/or inbtAll the work hefbin dibcribed. This <br /> ipplieatioa ib "44 th 6*11i1f`it4'frith SAtI jft4tiin Couhty Drdiitatie4 No,"549 and 1W ghd the ftuleb'edd RegulAtione of Sin <br /> Joaquin County Nbllc H#kltf► BLniic4ti: t+ .& }Y, p;,.. <br /> sJob Addretti 2-00Q m r Yi�t, f Y►�dr�^ /� � Gity _ � Lot 'Sl to/Acr4�e 1 oft r !h <br /> ! 50.. Som k3his...tc <br /> IOwner's Name A-Unt>±;10 A tow.e:,rk fl.Y�: Addtess` Sd S. +t I C5� 4- u ..5 P nee Z - -t` 7 I <br /> ?33 17'f <br /> i <br /> COntrdti0r Q5 7JAdL !+� i ` AddteSS I G5 - <br /> rsr f Js� Cerddu-it CA License No. � �� Phone � fo 1 <br /> TYPE Of WELL/PUMP-,,1 { NEW WELL + WELL REPLACEMENT Cl DESTRUCTION Cl Out,of Service Well <br /> ` t "'/ 0L1M0'IN9tALt•ATi6N-0 }- .j SYJtEM WAIR L-] OTHER O Monitoring Well. ! <br /> t <br /> DISTANCE TO NEARIES :. gCP1`It; tAlVlt S Wei LWI=S �SC�r DIS�OSAL:FLD.JARQr PROP. LINE <br /> AGFi1CUiLfilk �C7T,f�€� Vv it 7S�i fel`S/'�UMPS a t . <br /> n Industrial Oper1 fiottem C �i AbIPIUM AREA 'CONS f�ucti6r4 S'0E&iCA+t0h§ ' <br /> r INTENDED USE fiP0€ OF W�• " <br /> J3 Nlaht#6 + Dlll of well Eidivation if, f 0_ Dib. bf Well Ci6ing .�c�► ; <br /> 1•:i Domestic/Private �Grsv�l O4Lk� 'l3 tract' ; j I I yji6 df CBisinp_�ac:1.. y fJ Pd Specifications ! t <br /> 11 Public [-I 131h61 I ri fldlte '; 'i""" I]i ih bf Ofbot tesi Fta= of Grout 316 ! <br /> I I Irripalibn '�Q Apitixa*, Depth „'iI164(ein g 5urfjce S�afl <br /> Repair Work Done U Type of Pump i gi t#Wd);rk Di)rid ? t ! I <br /> r6Q r <br /> r Will Deitnietibn 1NA(I Diifii4fa� 4 i� �[ 84ding [Ilitdri&i A Depth --., .t_:���++_y4 SO i 6-0-4- 1 " <br /> t ». beptft 7-0_ -rSf.4- kidii �1W16 1ii'ri t4th ,4 0.E1/c�.+.eS.�-�Sur�= gIVI O <br /> ' <br /> "TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I fNo <br /> pie sysl00 ermi.tlted if publ <br /> Av4!ibYhinpfeet <br /> Installation will 000hdidbric6 C6thMircibl; <br /> O <br /> �I Olher <br /> Numbef of Nving uritis; a �3um�ier of �ad�oom I <br /> r f i 4 � . <br /> Character of 0611 to a 460th bf 9 feet.' : _ l <br /> f <br /> SEPTIC TANK: i _ I i . il� �llt4t tAfile dedih j <br /> :O type/Mfg' s_ „ , s Ctipacity i Nb. Cdriib fitments <br /> OKG. thtAtMffit FLY. 0 MAnd of Gls06sa11 <br /> j ..- `bistane4 f6 nalrl)afi WAN, ` oCYridaiiori— Plopirfy LIAO <br /> • 7 1 ' <br /> 1", 1 I� i j <br /> UACHING LiNtt" .t1 'No I Liriili! 81linli6 1 to 'i lengthle�xe E 1 <br /> FILTER BED , n bmatified to ItiedtAsi:; We Fauhdetibri ».._ .k !iL, Oro" Lind-..L + <br /> Sf:frAe3g P1fi�, fl i Papllr __i i "" . „Tit+t i— _ , ; • Number <br /> SUMPS [ �1.:.Dlsfttinre t'b h+ya�tbfit'° INo1I... !_ r~-.pduitdati ri= _x. ! Orobb�ty Lir1a � <br /> ' DISPOSAL PONDS, } 1 ~1 i ` r• . <br /> a t C] 1 t a <br /> i I hereby certify that i ha+;b pfAp$tea NO 0011esti$ft Affil IhaS the work Will be dobl IA 4ccotdAnce With W Jd4uin county ordinancas, State law0, 8nd <br /> Homo owner of Iit etiiad M Snell ii hatua t3� y i. ' •' <br /> 4 rules afid'iepulitiot5! br t1•ia 96k Joj4ultf t'. 1. i i I I 1 <br /> i fi Lsiliifiay0 ihr5 fbllbw�ng; "i eariify tflit Initlto derforrn&n a of thb Work for which this pbrmitis issued, 10hith not <br /> employ any fyalitfffi 1f1 illt)b1i it�Ifihiyt iilf td 81 idfn"i#�f6Ji f Ib r`V4ffirr lin' CSm{3i8d4ffi5n kiwi i3f Cglifotnii."i C661ii cfor'll hifiiig or Aub-t-Mracting signature <br /> # A F <br /> • certifies the(ollowfno, 'I i;Ertify th4t Iii th11 petfotrrtfni;a 6f thi*&k for Which fhje purri�ft is ia�uad�'[she[[ mj,fay 06r0ons subject to w6rkm4n'e coinpenea- t <br /> I tion lives bf Califotnla." j <br /> The llpplid a A[1 t8qul? 1406.0II6riii CoA0144 drAWing bn f6vAt04a tides <br /> Signed i "title: t E).�' i Date: S Z C1 Z- <br /> _; i 0#011 0040m4fe Se g6NLY <br /> Applitaileh AcEli'pfdd by; ! y,-' at 4' : Det Area <br /> a Olt or dfout Insplkiloll 14, W6 Plridl lhipietl6h byk bete <br /> + i ! i.. <br /> Additional Commirits; <br /> Applicant - Iteilitti ali etpieH td., Rritl �OLtlttiB, C6uH-ty pUf if6 9HAitli Se5rti16 <br /> •^�-. . ;•�^ �'. ',. � «,$rivilonrebtit>il Heiyltlipt+t•'r611t/8ern""iceA n ' <br /> w i-_ .:. 1 r! «rr445 ,•sill JotiquiKi;P�O gox,2009; stlfni C3A.;ti52b1' <br /> PEf" AMOUNt but . >" �raA�ffLjN7 gEdiil�#Ed��� 1- <br /> INFO' CA5H, IECE1IID SY VAt#c blciilVli7'NO. <br /> . EH IS•N(REV,1/At I <br /> EH 14-20 <br /> A <br /> '1 <br />