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{ SAN 'JOAfatftN C()umt'j Pi1$LIC nALTH SERVICES <br /> ENVIft0k YNt" HtALTH DIVISION <br /> 446 N §AN j6AWIN; PHONE (209)46$-5420 <br /> i P O l30% 2009; STOCffTOR, CA 05201 <br /> F ; dIT:.E%PIRES .I .YEAR FROM DATE•; SSUHD � <br /> (Coinpleto i6 Triplicate) <br /> Application ii h#jtjiy m'"A td Sb.b doa4uii3 County for a permit to construct end/or install the vork herein described. This <br /> applicatioli 1e iAai in,co4liilnch dith Uri 1o&quin County Ordinance Na: 549 Mid 11362 Mid the Rults aild Regulations of San <br /> Joaquin Coterity Public 969,1th S rrricee <br /> Job Addrait>j <br /> 7$10 Thbrnteri:,Rd. l City . Stockton tot Siie/Acreage <br /> t <br /> O* <br /> War's Name <br /> V611e Comtr6rCi6i M0 Addrest Phoke <br /> _ ''.�y� 4 ' � 6Y�1•€-fi9ec5t1 .H�.r.�-�"j.y..�%.�-rM '' <br /> '15 ,�2} 'y /� <br /> Olt . <br /> ,� .' l' F j 4 Y1 -+� �•t t� - tl t r-' Oma/ <br /> Corthtct& ".6tion AddrAss`7� <br /> License No: ;f Phone, <br /> TYPE Of WEttIPUMP: tNEW WELL ❑ WELL REPLACEMENT,C-1 DESTRUCTION C1 Out ooiiitoring Well ❑ <br /> OUN�IO W9tALLATIOfJ t3 SY5T1 M ftEPAlli C1 OTHER bOtingd wi h one <br /> DISTANCE TO,NtAAW: 90tiC TANK - SEWER LINES DISPOSAL OLD. . PR _ —op—CII 20 <br /> FOUNDATION AGRICULTUREHE <br /> WELL OTR MU KITS/SLI PSH le <br /> INTENDED USE Oil. <br /> OE KNELL .1 EFIOSLtM AREA CONSTFiUCT)ON SPECIPiCATIONS. <br /> C7 Industrial. ❑ Open Bottom ❑ Msnteci Dift. iif 1iV811 EicesvBtiorl DIB. of Welf Caging <br /> C:1 peirestis/Ptivat6 Gl Gr$ugl Pack • 0 Tr3Cy fiYPs n1 CesinO_ <br /> $pecificBiiehs <br /> I'I Public rl.t71isei M 156111 booiii 61 t 06w 9641 _ _ *YP6 at Oreut <br /> I I Irrioa.66h, Appidll. 6011 i 1 I twark, $uri$cd Sial insiaildd by <br /> Repair Work Doii+} L7 TyOi of Pump H.f. �' StatB Work Dohe r <br /> Well Deitructi8n. .,,,.,,O. Vvel1 OieirAiet :. Sealihi 11J►t1:riA1' ;,,Di-,th <br /> D pjh kiilr=r' kati4ifti L i*p�h <br /> TYPE OF SEPTIC WtRKt NEW INSTALLATION I I REPAIR/ADDITION'( I DESTRUCTION I 1 INo septic i:ysldm perrnitted if jfublic sewer is <br /> aysilabli,Withln 2001 lest.) <br /> Irta'i811oti8n viii Iieivi: f`19#td8nes� Do�nmbiciaf � t3iher — A ' ` ,r•'* �' <br /> Number of 11Jind un1ttl= Number of 66d►o6m# <br /> Ch$ratter of aoi)tti i d6"dh of 3 febi: A Wet6r tBbfi depth- <br /> SEPTIC tANR((' b TvdiiMfg C$pacl#y No. 4amplertrtieint$ <br /> PKG. Tfi 11TMf=N Lfi;'Ci Method bf Oldposal <br /> s Distiihce to niirt}itt: Well koiiFidAtloii Piop1lrl,r,lini 7 <br /> LEACHING LINE IJ No. 4 Lingtli of 11hei total iengthilitia % <br /> FILTER SED -__ .hliitiiie8 to neiril:`t: Weil '= ,Foundation Property Llai! - '`� <br /> ,_. i. .. L <br /> §WAf3E jsii§ I I . 660h Number> ,. 13c11 <br /> SUMPS "L1 Noma ib fwf6m: WA jj `foun�lfwon Proiaertyllh <br /> DISPOSAL PONDS ❑.«i., .. �n. 'i r .'a iv r .. ei <br /> I hereby cbrtffy ihst I Piave piatbired ihi§4app11tmioij 4hd thiif ihb Jilork Will.bb dbhe in accordincti with San Joaquin cougty ordinances, stale IBwaAi-6 <br /> rules And reguNtiohs of the $6n Johi;ulri C66fitjr r' <br /> Home oWnBf or lic$na$d a¢6fit'a ilgh$tu'rd Cbi{ifib§jho f6116wing: "1 certify ihit In 1" pdrio'imance of the work lot which this permit is itsued, I shall not <br /> employ any pereoh in aueh mk&Ar&s to becoiini iubiki to%korkmf nik 6ompltn85Non laws 6f CilifornlA."Contrai tor's hiring dr sub contracting signature <br /> certifies chi 1oAowi6d'. "I t ikh chit in ttii pijforinAh6i of thi W6rk for which thilk p6Fniit 4 isiu6d, I shell Employ p6ri6hi subject to workmin't compensa- <br /> tion liwi_of Celmmifi:"' r <br /> Th6 BpOkAni muii 1:611 fbt x101 tUq 446 in9001df i. t6tnptete drAWih iln Fi'!varia side. <br /> 4 Signed Titfe. 4 _ Ste: <br /> . , - r oti b�i�df�l�l�4l�f+f1 i1SIE i71JLV 0 � � `'� <br /> Application AtciptedtV., Deal res <br /> Pit 6ir t3r6ut Ifto6olorr 6V,; Dat$ Eine1 InAjifletion by — Gate <br /> Additional Com"MO: <br /> Applicant Retdth 61�copies,t[i. Sate Joequiti Cotihty fiirblic tl6aith Services <br /> 9ivjYOfili6htlil Atilth Perinit/Services <br /> l - �-4415 W rSaii Joiigttiif r'I? 0 floit 2009, StkAj CA 95201 0 <br /> 1TTEi3 t 1C U <br /> 6Y a S <br /> 1] �1�tlt IT'f1p <br /> EH124 TREY.1 51 - <br /> EH 11'.2t <br /> y , <br />