|
1, 4
<br /> APPLICATION FOR-'PEfZMIT = '
<br /> 7 " SAN JOAQUIN'COUNTY PUBLIC 01-£A1.TNI SitiRVICilS
<br /> " F_VVIRONSIENTAL ILEAL I. -DIV'.;SIGN - 'F
<br /> P 0 BOX 2009; 'STOCKTON, CA 1195201 a ,t c i
<br /> (209)' 488-34417 ,, ` +' {
<br /> } tG e '�S +tom } 't.
<br /> E
<br /> irq T 1+; . (COMP1ULC iR Trip11iC&L9) "
<br /> ,APp:lutton fa hereby mnde,ta San Ja4qutn County for Derc:t to corttruct and/or Snetei.l the vorK.dereln described - Th1e '. a -t
<br /> application 1a-maGe In c�llance vlth San Joaquin County Ordinance No:t 5LS and'ibb2 and the Rules and Restlla.tiona of Ban"� .�;
<br />! R fJoaqult: County Plrbll[ !!ealth Rervicee, i inti T• w _ } y, r
<br /> {) I' JYQq��JRLy. C;ry _"S k"
<br /> Lot 9lLelt.:reege �QlY
<br /> f Job Address t 8�"
<br /> t]d.
<br /> `�^ �• Y r,J.� - ^_ � 1
<br /> r, c5r-.,
<br /> aOwoer's Name Q addoess t �d Phone
<br /> J, ti4. Conlr�Ctof AGCfe SS !. - L�}}rClnS!
<br /> No. PRtln!' •{ ...-.+ + � $
<br /> TYPE OF WELLlPUMP,� NEW WELL WELL REPLACEMENT ..i DESTiTUCTIDiJ .1 pit of Serrlce.lJeilyO ,f
<br /> . i Ai
<br /> '"2!ilonitarina VellL
<br /> PUMP INSTALLATION C - SVSTEr.M1 P.EPatR C K_f7
<br /> DISTANCE.TO NEAREST:'SEPTtC TANK SEWER LINES i- DISPOSAL FLD.` I'ROA,`UNE
<br /> 1
<br /> t FOUNOA7:ON AGRICULTURE WELL ��_ OTrtER WELL Pt-S/SUMPS
<br /> 'tNTENOEU USE' TYPE OF WELL PROBLEM AREA CONSTFIUCTIDPJ 5PFCIf CAT!ONSvl
<br /> °
<br /> ❑Open Batton ❑Manteca Die.DI Well Escevatron 4h - - Dia. of Welt Caamg ''
<br /> DomsiticlPrwefe ,; L-1 Gravel Pack C Tracy 'Type of Cas.rg_I :i L. ' t`--Specifocaironi'
<br /> f'i I]her' Della' Depth of Grout,Saal Type of G
<br /> k Public } .., .p r4 F - _
<br /> t. ''sr s1R fi+' ;r F ,.G lrropetion
<br /> -.(27 Aptxoa. Dep:n e0 0 Eastern -
<br /> Surface Seal Inuanad byle
<br /> SaPai/Work Done .LJ '"-7ype 01 Pump H.P. Ali Slate Work Dona
<br /> Stall Material i Dtpth d� � r
<br /> Will Destruction '!D W011 Oiamele,.�� � �, ��Ok � x
<br /> tip - � _-% •v ,- t'. .. - Filler Material ✓, De t!t �;u'., `, o
<br /> - .
<br /> Depth.:;.. P4 - -d*w "' '�'�4",�
<br /> r ,.y_ '1.TYPE OF.SEPT;C WORK: !EW WS'rALIAT i N 17 RSPAIRrADDIT;UN•Cl D#STRUCTION G,INn septet system rmuted I Public sewer t {`
<br /> y�yy i �+ T Yq ( ava'dable wil fest.1 '''" T:-' `E,• r
<br /> NM1`t F.0 `v#^7F'. Yi ! �'. ¢' � v, '
<br /> Illation will"me -Residence_ Ommartiaf Oihet
<br /> IF r p s L �t
<br /> IY� - E Number of living units. Number
<br /> Charscler of soil to a depth of 3 feet: .,� '��i Y 'Vlater table dePtfi•' -'r °` -' r �.�
<br /> -a#� '"' v� SEPTICT►NK O TyptlEllq _ n aPacitY No Compartrnantag� 9^ s y l �
<br /> I '; T' � , '- _PKG.TREATMENT PLT,C1 w ' Method of Disposal s� ,
<br /> £ '� ;+
<br /> Distance to ne Well '� Foundation !�' ' P,ops"V Lina u. }s axS
<br /> *i ''1tx Torsi lenih/sire`T Wit* f .,. �r xn%K""^tev'¢'hA .« b r►;,' ?.
<br /> �sb ar• � a �: r• -s
<br /> LEACHINGLINE. ❑ ND:fi Length O1 iine7 .ly g. ,E:t4 •' y" yixt 'r�I '> i
<br /> -'FILTEN BED n Distance to neereal: Well Foundation Y Properly Une iv
<br /> :.R
<br /> r n - d '. NJmbef s :;:a• s :r.c"
<br /> I r• tyt:� +`� +, s�, (`",SEEPAGE p175 I I ti DePlh ' Sirs a,
<br /> Sumps,
<br /> ,DISPOSAL
<br /> �LI Distance to nearest: WeEI_'��` 4.FOclitdaSion j�A Property Lone
<br /> G - _
<br /> J ! r r' t i st�:3r t 1
<br /> _'.,DISPOSAL PONDS ....JO'y
<br /> I 'll-heraby'urtify that I have prepared this app';: and thai:inawD will_fie done in ecurdancel with San Joaquin county ordina,7ces,slate lawi�and
<br /> - v t II ,rev ,.F r�swXft :r
<br /> '444?_ 'twist and rag
<br /> utations Of,the San Joaquin Govn:y - ,' ''.+ ! •'� ^. '�" k.
<br /> °j -Home owner or lieensad aeenfa sipnetu+e cenirieS the rdlowin I cenilr Thal in Ina penormancet+the work for which Thos-permn Is iswed;�.l shall noI is
<br /> I �• .' k'•'�.'t'-u •yrsr?"1, snriM tov any person in sure:manner as to become wblect to woe man's Compensation laws of LBlifprnie."GDntrat[Dr'a h finq Or siJb-COr'irat ling-aign�TUfe ~
<br /> n
<br /> J�e^' rRifiu the following 'I Certify that in fM performance of The work fir which this ptimil Is iuved,I Shall employ pe�rwns fubiectF o workman's compena>,
<br /> rn. ilon''lawi of r;aCfornla.' s - �.�:pp✓."-
<br /> +� •r +E��U §� The applicant rt+uat cd aq required ins tions.Complete drawing roverse side.
<br /> nes r fd Y +lZa
<br /> ,1 t I er.s ,fir I 1 fp,- kr Date " ?s
<br /> f +. n. 1 r OIL Title AA v.
<br /> }s�? Signed
<br /> ''Je,•wFf s.:, �'S'r-wu Tr`,rY,TxY e'r�.4 Sir".r. "J: .. �. 1* ,� g.^� � Y3
<br /> ^ '3tt OR DEPARTMENT USE ONLY
<br /> ,la,{}g$„w' r "as�"•.Ff'r gata� 1+' Are ''�a .{!�
<br /> RA Apabcatlon Accepted In
<br /> s 1 rr.Ks ,t ;•.'*+'� k -'-�• I" t �i.s. `;ry -; , ,([�/^J� se5 s.ar. 7 3�
<br /> Ficial Inspection bYi� .•map f v zx' FDate'f`.t ..
<br /> s'• > �.,, ra.tt ,,f"r,, Pit of Grout Inepeetron by - - _ Date _
<br /> L, 6f -tY •yt `' i.s '� r, } `
<br /> Additional Commanta
<br /> t i'.,�•+ h `�'- APDl scant., Re t,:l'n all Coplal, SAN J17hRD1M COIfNTY PURL[C HEALTH.y6Ry I CES � ,r!t" K 5 t�' E + '
<br /> 3�x r ,. 4�� .,1rLs•S'^I. - LsIVIRONMCNTAL IIEALTH-DIVISION PERs1iT/SERVTC£S g'* t- - Y C i•r ,( AJ'�j,t
<br /> 445 N.SAN JOAQDIN, P O lf0k 20D8'; ST(x'KTDN;}CA'85243 - 3 1 i.i.
<br /> Y , plc . fi
<br /> I t54` g81,
<br /> c° ytrr" `pie I` FEE.- r it a r R'EC[,VEC H�: r Dr TL FERMIT I;D.'
<br /> n' Alf r Y INFO= fAMOV NT.CVE Y aMC1liNT,nIMII'TTD CA$N -'�
<br /> is
<br /> #'� -F` :wassy .c,P w rii'r` ;y..,.vp,pT„r,�:u""i.e'' .:, trsdgr. :§t• w'.�.. '::'If -
<br /> ' F AK—or
<br /> 4k4r � �. Af '
<br /> "'' rt j• R-"h 'd'i` 3p ##{�i- "'^r. •. e _ ,� ,ter .y3r.' '�•:,` Lfn
<br /> `"•�.y�.-'a,r,#I; xi s• y �„ -7 '� i; .�, �r}p N
<br /> �;y4{'�2i ,I' #T � � �'A -: f _ •k ^I. - •''` - �� _ ,yj �7��4.A^�� .
<br /> ..>i .,�tY�'"Jis rt�,��..sps� F� ''�""p s Y �.a ri•.. � r3§:�x n � r .r C-> "`r k i7,L �!+E�,
<br /> b §. ,.s""l i
<br /> .V •w;
<br /> -
<br /> �..� r. S
<br /> `--ai. .. �7 'e
<br /> +_-►'t z x .s6+xa`�.'11.k_'�-rq�rr^.-:.Sr� +A:.Lx `'"-:�—. _ .t.�.,,� .��_.�;��'�.- ..-- - J:}"' _ _ ;'�k 'y =t. i ._ :.�;, -+.{-y,,... F kr-'-;.;a
<br />
|