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ffE <br /> . MAY 05 'S5 09:310M ANLERSOSLLTIMGPLICATION <br /> S3N JOENVINRCCoIO tiTALPUBLIC H ALT1i DYy1SlON S <br /> 445 N SAN JOAQU PHONE C2CA 9ZO <br /> 5201 <br /> P C EM 2009, 3TOMTON, <br /> T =IBES 1 YEAR MCK DTE ISSUED <br /> (Complete in Triplicate) <br /> rmit �netnyet aad/or :-oetaJl the wrk harem de5crl'Jd•. Tbiff <br /> 9.11 <br /> to 9na Joaduid ;joeq for a pa o Ilo• 519 � 1662 <br /> sad the Rules evil- <br /> is <br /> bd fte6t>].atlma or Sea <br /> Apylycetloa is hereby sad&. m" �'b �n Soe4uln CouoLY OtdYyaac <br /> eyplieatim Is made in etas Li - <br /> JoeQnia emhtl Tzhlie Health serricea. ^ Lot 31xe/Aczeage ----- <br /> - a Ga <br /> ase- cG 1,-f fj` _s - <br /> lob Address Ar � r�J(}1'� Phone <br /> Ge 1 t f ss <br /> Owners IA Addre <br /> Name T A _ 11tt Si?fione 419'% <br /> A (2 Gam' b=1( F 'd O NQS EVA Ire✓ License EST <br /> /Ti r40n rjPSNI'�'t+f�L address pESTAUCTION ❑ Ouv o�fqeh$eo`icc Ne11 Q <br /> Contractor NEW WELL O WELL REDIA CEMENT G OTHERXi 5 9 oKing gall Q <br /> TYP£OF WELLIPUMP: $Y STEM REPAIR O pgpP. LINE Y <br /> LLL � PUMP INSTALLATION Q DISPOSAL FtA. <br /> SEWED LINES � PtTSl SUMPS ._ <br /> DISTANCE TO NEAREST: SEPTIC TANKAGRtCULTVRE WELL OTHER WELL <br /> —�— FOUNOATIO14 <br /> TYPE`WELL <br /> PROBLEM All FA CONSTRUCTION SPECIFICATIONS Dim. of Wom Casing <br /> INTENS <br /> ClQ Manteca w. of <br /> ❑ open BPWeY EKovation�--- SpePlicadons Bottom of Cnrr-9 <br /> L) Induetriel - ❑ Tracy TrW d Grout_____.----- <br /> Cl Oornestic/Private G GnvM Pack (1 t)elta Capri, of Gran Seal <br /> Ll .� <br /> Omar <br /> I'I Pntdc I I Eastern Surface Sed tnsr+Ilea byApprOa. Depth State Work Done <br /> t Inipation L] Type of ftnp M.P. ��� <br /> Repair Work Dan& 9es " Material k Deptb <br /> Q Wee Diameter .�-•—� [pIt"ev;�SIGEri'f �n�7tG e <br /> Wag O"Imcuon f R 5 Pdller tasuzi.� L Depen <br /> pspth <br /> avaifaWa within 200 lear_I <br /> TYPE OF SEPTIC WORK. NEW INSTALlA710N I I REPAIRlADDITICN 1 OFSTRUCTION I I {No septic system permitted it puh tc sawn <br /> Commercial Other <br /> Installationwill nerve: Residence <br /> al bedrooms Water table deorn <br /> NuMer <br /> Number or IivinO Pnile:— No. Da„pytmante <br /> Chmeaer ar edl m a depth of 3 Exec Cfpacity� <br /> gEPT1C TANK <br /> ❑ Typaikilfg Madedd al DiWtsel <br /> PKG. TREATMENT PLT,Q Foundstidrt Property um <br /> Distance,to nearear. Went <br /> Total Iengthisize <br /> LCHING LINE Ll No A Length of lines Property Lira <br /> EAFoundation <br /> FILTER 8ED O Distance to mil-srWil <br /> NUmher <br /> I I Depth — S12s ?spar v Lim <br /> S�PAdE PITS Fomneetiore <br /> SUMPS LI Distance M nearest: Well <br /> p15POSAL PONOS ❑ m chanty ordinances, scam laws. and <br /> d. I knell <br /> I hereby canilr Eher I have prepared lh�s appllca[iOn end That the work will 6a done in BCCOrdanae yeti, San Joadu <br /> that m the part area a Of the Contractors for otols Hifi gsOr su�mntnctin9 signature <br /> rune and reguletidM of 1M San ,dies the folklwing: "1 cenihr sa4an IasNs U lb w9rkrNn a cpmpanca- <br /> Hpny dwner er licensed agsrd e:to workman's compo^ le Towed.i+hep empltly wrad"m euble <br /> �lpy sny ps+°^ n such manner as to became aubp <br /> certify drat in ms Performance of tM work for wniUh tftis Parma <br /> ceni{es ow fdloforni ' <br /> tion{aYA of Callfontk." wing on rmrarM mics_ <br /> N�p Ted nsoeations. CQM0*le Ara r� t'r Data: <br /> The aPW� t for,ai/ Tide: 1- <br /> Sigma dC <br /> FOR DEPARTMENT VSE ONLY <br /> Date <br /> ! Area <br /> Accepcad by <br /> Apphcrtion Fine,Inspection by pate <br /> Dare�-- <br /> Ph pr Comdr inspection by —� <br /> AddidOnli Comnrno: <br /> anvirowenu.l ffe4l O H icy009,13tka. CA 95ZO1 <br /> Applicant - Return all copies to: San Jawula CoueCY pabllo Real ti, ger cc <br /> 445 N Sam Joaquin, <br /> RELEIVE6 9Y <br /> DATE PERMIT ND. <br /> F*F07Eq=!J! <br /> EH 11N EPEV.."41 <br /> IN 1Lae <br />