Laserfiche WebLink
S--- � <br /> 4, = 0A " VW <br /> . hNs�" ftg <br /> =W <br /> 4' <br /> Al•k-w ATION I-OR PWWIT l <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONkENTAL HEALTH DIVISION <br /> P O Boa 2009, STOCEn`ON, CA 95201 <br /> (209) 468-8447 <br /> (Complete in Triplictite) <br /> applicstlos is hereby nada to Bao Josquln county for s nersrlt to COnstre:ct and/or inatall the work hereto described. Tale <br /> soaquin County <br /> fa ftWo In oaepliann vats 8ca Joaquin County Orditunee No. 549 and 1852 Lad the Rule& and Rtr"tlons of Baa <br /> Joaquin POutity 1011a Ye tb 3eryip`es. Cl��.re�low <br /> Sam-i'+� �� ' E.ca S�` '* Sf- <br /> J( Addrtga A e u v I� <br /> - _ ---� --'�"��*�-- City�� Loc 81se//terea8e <br /> Orwwrsa's Name y ' 0� = 'bL _AGdrea <br /> r <br /> {r✓�. t; Yar. VSR Inc} Phone e3 7" <br /> pyo 4 L4 l,' <br /> '1 L <br /> Canusettx Cc .e1 �'*A�dress Vwe C L� License Ho 3 3 7• Phone -7�3L? <br /> TYl'E OF WELL%PUMP: NEW WELL 0 WELL REPLACEMENT 0 DESTRUCTION 0 Out of 8errlce Weil <br /> PUMP INSTALLATION ❑. SYSTEM REPAIR 0 OTHER 0 Monitoring Well t <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DtSPOLAL FLO. ?ROP. LINE u <br /> _ FOUNDATION K "- AGRICULTURE WELL OTHER WCLL PITSISUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Cl Industrral 0 Open Bottom 0 Manteca Cia.of Wes Eseawtion �!1 <br /> c ����p���� ,. Dw.of was Casing <br /> Qt Domestic Pfivai 0 Gravel Pack 0 Tracy Type of Casing QI�C Speciiieationa <br /> felfr C7 Frrdie w4'Mpt' 1?Y ►NrM•(JJC 008118 Depih of Grout Seal : v 1 Type of Grou _�—& <br /> A . <br /> I kcgnrw+ fv <br /> Apos.Depth 0 Eastern Surface Sart!nataued DY .•r w;b telll <br /> 1 <br /> tl - lteps+r Work Dona 0 Type of Pump Am!:E H.P. yltvi c _ State Wort:Dona <br /> Well CtStyCiun 0 well Uiamcur Dealing lleteriLl i Depth (—/ <br /> Depth 1111ar Material i Depth S <br /> TYPE OF SEPTIC WQRIC: NE-V tNSTAI,LATION D REPAiA7ApDITION 0 DESTRUCTION 0 (No septic system permitted if pubIC sewer is <br /> - Available within 200 lost.)Iragpation wap aeM: <br /> Residence_ Commereiat Other <br /> Nurntw of F4ing unite: Number of ballrooms - <br /> Char:cter of aqui to a depth of 3 feel: Y.'atu table depth <br /> SEPTIC TANK 0 Type/Mfg __� CapacityNo. Compartmanis <br /> PKG.TREATMENT PLT.0 Mathod of OiapoW _ <br /> Dietsnce is nearest: Wall Founaerion_ Property Line <br /> LEACHING LINE 0 No.i Length a(lines Total Nngth/eine <br /> FILTER CEO 0 Disranco to nearest: <br /> Wall—_ FaunGarion t°roperry U•.t <br /> SEEPAGE FITS 11 Death __ Sire Number _ <br /> SUMPS LI Distance to nearest: WON Founds".—'�_ <br /> t� <br /> DISPOSAL PONDS 0 Prop"Llna <br /> 1 hereby cltnify:Ml 1 he"Iaep&rad this application and that the work will be done in accordance with San Joaquin county ordinancas,state laws,and <br /> rules rMd requisticns of 0,e Sen Joaquin County <br /> If Horne owner of Ncsnsa„&,le11's signature co lifiaa the fanowrnq:'7 eenily that in <br /> OmploY any psryOn in auCh the performance a1 the work for which this permit is issued,i shalt wtrNn,�ef at t0 become subject!n wa(kmen's compensalion lawn of Cal,fornia•'•Contreclot'a hiring of wb•CiMtfatting signarpU - <br /> ewnlfiei iM fp"forrp:"I csrtif{ttial in the jferforRenCa of the work for which this permit is issued,I shall employ persons subject to workman's coinpansa- <br /> _ - t14A laws of Ca4ftlrltl&." i <br /> Tie applica at"1� � squiredJ' tient.Complete drawing on to eras side. <br /> xlb <br /> SgnW Title: Date: <br /> f�r, FOR DEPARTMC`Jl USE ONLY <br /> Appliealian Accepted by � .w•t d _ --_. 08 to !� G A.)" �s <br /> rtl <br /> Of 01010E 1AXW iqh by Cate_ Final Inspection by.. —_Date <br /> Addidonat Comments: <br /> ` 'Fplieaat- Return stl copse■ to: 9AfI JOA4JIH Lti1(DIlY P!lHLEC �U ; Ca �.���� <br /> DIVIRt'MIENT&L 'HEALTH D:VISION t=mutt -AEWALB 7HDMSION <br /> 443 X SAH JOtiQI)IM, P O BW 9009, JSUC7C <br /> FEE <br /> IWO - As�tONNT DOE AMOUNT REMitT$p [LSH RECEn r _ .,n <br /> •SER tti2�1LLY.vaar �6214 <br /> - <br />