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<br /> AA U.1CA 1'1(.;,N FUR 4!'1.,i l.W JT
<br /> SAN jOAOUIN COUNTY P U.3 1A C illlll"Ai-'flf 'iF.RVICES
<br /> '14TAi,
<br /> F..N V I I?eAS A
<br /> P 0 BOX 2009, -STOCKTUN, CA �95201.
<br /> C209) 468—'344-7 l
<br /> r
<br /> A pp.,c a 'on Fa hereloy mde 5,r: 1 cn,u i r, .nun:.! for the vort. I:eretn described, T"',6
<br /> Is n-%le In colwll."Cr --,h 5-n Jz+rjlr, and 'lje Pu,'ep ane: PeFrjA.oria of Sarl-
<br /> CoUrity P.',IIC l`."!.h
<br /> /< lr�tc.�.Jre
<br /> 13.1 ,,�Jot) Address 6 -V
<br /> owners Name
<br /> T
<br /> YVE OF WELLIPL;" P ::EN V,ELL V,LL. r Service we.11 0
<br /> PUMP i1jS-.ALLA1ICJN Yor I tor,ng well
<br /> DISTANCE 70-NEAPEST. SEPTIC TANK 5[1,','ER L I,'.;:cl C'[Sd:'JS41. PqOP LINE
<br /> FOUNDATION_----—----- AGRiCULTURE WELL 0!ri;r Wti-L PITS,15U.MPS
<br /> CONSTRU,17�G%,Sj1fCiFi CA Tr rONS
<br /> iNTENDE0 USE TYPE OF WELL PqO9LL,',i 1REA
<br /> ..r 1ncr.slnsl open Bottom 0 M4,%leco Ora 'j,Well F-CAf,rn ------ Ora. of Werk CA5;ng
<br /> DorjesticiPrwale Gravel Pack F;Tracy %pe c,!Ca,.rg; _ spirc,ficiihoni
<br /> Public r1 Omar t7 Oel;a n!Drpjh, � Type 3f Giout—LAALKI—
<br /> M lj;ajP0M A01,40.. DdVth 0 EVIIIi— Surface Se'd ink wv,i
<br /> Raps,?Work Done 0' Type of PLMP �",* Staling litateriol' S:art work Done
<br /> I :ep'h
<br /> Well Deslrutti0r� C, Wall D12mere(
<br /> Deplh }'Siler MAter1fsI
<br /> 0 f r -.
<br /> TYPE OF SEPTIC WORK:, EW IW��TACLATiOt4 FIE PAIR+ADD67,10'4' rj 7J it IN server 110 OT orall J public sewer is
<br /> tl—.
<br /> a.j.;j6la wi feat.)
<br /> Installation will serve: 0:nf,
<br /> Number of living vn;ls7 _ Nurnb�--of be Qaj1
<br /> Chl'actV of soit to&dqplh of I feet: table depth
<br /> SEPTIC TANK L-) TyperlMlq
<br /> pac,ty No. Compartments
<br /> PKG. TREATMENT PLT.C rr Method of Di%4>01at
<br /> Distance to n reskrWell Foundei Property Line
<br /> LEACHING LINE Ll No. S.Lenglh of lines
<br /> FiLTER BED 71 D,stance to nearest: wMil Property 1--r.a
<br /> SEEPAGE PITS I I Depth 2:1
<br /> SUMPS Ll Distance to ri"tesz: wep P,opony tine
<br /> DISPOSAL PONDS
<br /> I hereby certify that I have prepared this OPPI-cauon antt.!hJl me.0', -11 tv(Johito.!cjic,jr,ce-(Ps San Joaquin county wdintinces.Slate Idws. andrules and regulalions of 019 San ioaawn Cminl.:(
<br /> home owner or licensed agent's signowra cerjol',eS the fLltj,>w�qo 'I trelllly 1-16.in t!;d th,)work to,which InrS permit is.%sued, 1 3"11 not
<br /> i This LMI
<br /> 1tao sig oalu r 0
<br /> employ any porton in such ounnar 4%lo Dticor�rr sut;iacl to ccrper.3aj,(�h law1 s u! hiring of sub-cortleaCl i n
<br /> r -shAu aniptuy persons svb)rrcr to woikman'm tompensa.
<br /> #r-ifiql the following:"I Centily that;r) 110 p-rtolnnsl�ce C!ll�e�cjk I.-which ii—cl
<br /> lion Iii-s of California." i
<br /> The applicant must cAlYRN all reqkwad 1nr.jYq 11-is Corriplele afmw.ng 10"u"d'.('L'
<br /> Y Sign d Title- Dale:
<br /> EPARTMENT.USE 0f
<br /> L)R L) PJL Y
<br /> tk
<br /> APD11CItion Accepted In --k "are Arca
<br /> Y
<br /> r P4 or Grout InspectionDiia Fina'1.1irp:1;;I,ur Dais 1 tz
<br /> Additional Commonw
<br /> ApplilziLtnt. "turc all ccp1mrs to: SAN 20M411IN C(MqTY VL:MAC "FALTH
<br /> El"I'VIROMPEt:TAL 1!FAI.Tll DIM-SIONPF:HY13'/.S;;Iivi J\
<br /> S•15 N J()AQ'U IN, 1' 0 110X 24691LA El 5201
<br /> "T
<br /> FEE AMLIUNT CUE 14T if �o Rf PIALA11 No
<br /> A 41 A S 'Cff�jj EN E)ATt
<br /> C C)
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