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- -; - <br /> ADPL Z CATI ON FOR Plj'sRU Y T 1<128z-/--556 <br /> 4- 4-0 S br�'^S S SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICTS � <br /> 20' 4-o Sd8qAe,, ENVIRONhWTAL HEALTH DIVISION � �r�rpAA <br /> 1601 E. HA28LTON AVE. , PHONE (209)468-3420 <br /> P 0 80% 2009, STOCKTON, CA 95201 <br /> tax z e`V-4a/3g <br /> I�7S1 -7447 <br /> (Complete i,fa Triplicate) <br /> Appltearion to hereby clads t4 Sea Joaquin County for a peratlt to construct and/or tnatalI the work herein described. This <br /> 9011ca1100 is Leede in compliance vith Ban Joaquin County ordinance No. 549 and 1062 and the Rules and Regulations of San <br /> Joaquin County Public Health Services. <br /> Job aodresa wK. a Sid {n Wa+ of (ort cgjko1 1 ` Si1 <br /> Cary., t-�Da s Lot se>ACreage 61�Z <br /> y1 Owner's Name Address 5540 S. QaabrG S reel Ped-`"-Phane 74/- D <br /> _k4.,��,(,LL/�l/� ZS15 �c.�t.� est ra �io3 � ca. go�w-�i4 �415� <br /> Cantracaor -- 7 Address /o�'T Gfs<. 9 �I �,ttnae No. `� 0 done 65-17523 � <br /> TYPE OF WELL/Pu MP;A/�} fr'£W WELL J WELL REPLACEN Tit DESTRUCTION O Out of Service tW01,1 ❑ <br /> _I / <br /> � PUMP INSTALLATION C SYSTEM REPAIR ❑ OTHER Q Monitoring Well <br /> UtSTANCE TO FIEF-RES T- UPTiC-TANK- - SEWER LINES .Z�� -., DISPOSAL FLO,SbCy snags. L:N-.-/00 <br /> FOUNDATION :r,lp* AGRICULTUAE WELL . 2!L` O1-HER WELL--,>—< � PITS/SUMPS <br /> V� iNTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Industrial CJ Open Sonom G Manteca 'K of Welr Excavation C)is. of Well Casing L/nq <br /> A.11 f l Oomasrit�Prlvare 0 Gravel Pack ❑ Tracy Type of Casing #11A Specifications <br /> �0 t' Public I: <br />