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06/20/94 09:5;; hlATER DEl,FLOPMENT INC '702 <br /> ata-m-xa <br /> 03:47RAPPLICATION TO . 19lLsvrtpP.g2 <br /> i SAN JOAQUIN COUNTY PUBEJC FVALTH SEkV`fMS �t `?' <br /> ENVIRONMENTAL HI?ALTFT DMSIQN JUN 5 1994 <br /> 445 N SAN IOAOUiN.PHON$(209)469-3420 <br /> P O Rm 388,st'Ocicrom CA 9576i b386 EwiRONMENTAL tE&TH <br /> b> TT E%PiREB 3, YEAR * DA Ig4II ATIsSWICES <br /> (Complete In Triplicate) <br /> Applraatkm k hmtbY Nada to ]oaghun t:paaiy far■pemtlt to 0onstru0t eld/oT inxtall the Wolin hetap tkscrlhed.TWF epptlesdon is medc in compliance with San <br /> lnagain Canary Develtlpaant Sehufoa 0-1170.3 aAd M 0.1113)rad she Au1ea end ReguLibar of Ssa J"quia cat sty Public EtrAt I Sotvlaas. <br /> .Ten Addmw :trs.:..:ge:UF' Gay Let Slulaareaie 7 Mti6 Aura s <br /> 0 D;R <br /> 0 w oes Name S Sh�Pi .]b V Address M Phbnc 6 <br /> COAtfgctar C�.r AddrRst• ... ..t Licenaa Jk. Y'J�2f. Phone Ivi- A4X. <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT M LEST UCTION rl Cut o[ Swn'ta well 0 <br /> Ute INSTALLAT{ON C' SYSTEM REPAIR,d `�*t...,ppy"" OfiHER 0 K°al>xs1tlg Kell <br /> DISTANCE TO NEAREST; PTIC TANK SEWER LINF$ 01SPO$AL PLO. PROP. LINE — <br /> OUNDATN1Fi AGRICULTURE WELL OTHER WELL, PtTS1SLVAPS <br /> INTEN010, bso TYPE OF WELL PRO6LEM AREA CONSTRUCTION SPECIFICAT{ONS <br /> h Indlrstnel O Ovaa Bot1 am _ [7 Manteca Ole. of Wap Excawtbn se".tic Lk \. r' ba. of Wait CaaMp 4.. <br /> l7 DomaaslelPrRfete Gnae{PFok B ff.reY Type of Galng k> �yy r fv t S�pl -r.,� <br /> I'1 Whnpa - OIMf fl Delta Depth of Grtwi $nal �i�a'y ea '+tipsem TYPE 911 Coeu1l <br /> t t IrNpalion L..APpiM. Depth I I enrtnrn 6unaof Sed lnctalled W - ns. . <br /> RepHr Wok Da1M .q T we of Pump V& H.P. vaA 5010 work anna,._ <br /> wait V 40 Diameter4Yt tom_' 8e4,lfca Matnrtal A .P"Ith w.h .i�cw <br /> wth Pillar 1Ytarfnl A Depth <br /> TY PT1C Won{(: Ew INSTALLATION T 1 REPAIR/ADDITION 1 i DEgTRU N 1 3 { Nptk avatars rctitta6 N ptMlir sawrb is <br /> araiaby wJtlYn 2Up fneT.l <br /> InstapeTlPn NIM carve: --.. CatnmalWl 661ta <br /> NumbaT at 4,ft units: mbar at <br /> S.{w"lm EI"ten of 3 hat: Wow so%*drpeh <br /> SEPTIC TANK O TYW/Mtq Capaanv No. Co npprgRanh�. <br /> PKG. TotwMENT PLT.It) AAatltde M G+ePea■I <br /> . - .bi0ferhae to nerraet: tA4o Fahr.detbn Ptbpetry, Lima <br /> 1.19AG41NG LhNE 0 Na. E LcnOth a,t papa Total 4ngMfjdSe <br /> HLT£R aw Q I DieWtdn tb awr w! Won Fou n tolh� — PtOPUTY Lina <br /> 992FAGE PITS I I Depth She� un>Ewd_ <br /> 6UMP6 - U vwAncn to." -arast: wall Fm.Zwon <br /> O{SPOSAL PONPs u <br /> I hereby raet#v then 1 haw,M contact ini& spcLK ;,n and that the.valk will M vane in axofdenaa with Suri ronpyNl county ORiMlahtaf,Steve Ie.Ya, and <br /> MISS SRO isoliabons of the a.loagbh Cateiy . <br /> Hama owner ar pcerteee eyahi's aignxura otimd the{vpawing: "i venally that in the oerl0mnahy Of the work for whish this pam,4 it issued,I s holl not <br /> .enptoy shy pnawh in.wc ernenner it tib la erfor anjeoo Tp wotkman'a ry0wemation laws of I:Womie,-Co.Oraatces Ndnp m wic-wn uicilty ognetwe <br /> �GwlNtb at�tlgx4in :w caMM that kt IthE oerfafenarhva of tet wArk tar%Mich th{s pwmh k IWred,I ahaM employ Itarsoaa woiecl to wtetlMflY aonY+enas- <br /> Tk►*Peccant rci,"cap {or Date <br /> sR1 uba°1r+ee+�tiula.CahvAere dre%anrng on twerw sidp. <br /> FOR WFPA141114iNT 1J;6 ONL •1�q qJ <br /> App4stlon AtntP pd by • 'jj <br /> Dete <br /> PR w O"llt inspection by Data fin.{IetPaaMen by _ ..J Dene <br /> AddiNenM.CMntiwnw L-/rl OR- Lm/33 !4 C- w � E'uJ 13 idI 4 On 13y A LM 1358 un13(Ufffc <br /> aPallaenL - Tlettu til all oaD1'ea Lo: &q Joaquin co my powic lith Servipce C- <br /> �I,j 1 �S Lvn%l38 81c-'81c- LNII <br /> 1 �"I <br /> 1T.prhoanwotN Hrauh Prrmhls6mlces <br /> 40 NL Sap-%do-,P-6.Hux 3811%stmkron,CA 95201-0368 g <br /> FEE <br /> AMOUNT <br /> 111" OWAMb17NT flsM17TF0 CG. <br /> ASH DATE <br /> uelv.tn.t <br /> ea+ PCflMR'Nlj <br /> O• <br /> R <br /> TOTAI. P.02 <br />