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a'rrl,ic,;t I tCN <br /> S#OAQUIN COUNTY PUBLIC HPATT&RVICES <br /> ENVIRONMENTAL S.EALT$ DIVISION <br /> 445 N SAN JOAQUIN, PONE (209)468-3420 R c t ; v c nP 0 BOX 2009, STOCYTCIN, CA 95203 <br /> s iSS3 <br /> e plleatl p is aedebin�e to My Joequto County for pat'c to Construct and/or instAll the York herein described, s <br /> Joaquin Cuuat omDllanca with S.o Joaquid County Ordinano# No, Sop and lAE2 <br /> -fY�}'ublle Hcal:h 8ervlcea. and the itulat sad PeauLttons of Sen <br /> Job Adurgs <br /> y 2J.�1 <br /> C'IY Lot Bitc/Acr.ya <br /> Ownw,s Nome '1 � Address Si <br /> .7i <br /> Phone <br /> Agdrtss S 5 �� <br /> TYPE of WELL/PUMP. N WELL G Licenit No. < - Pnene 4J 4•17;J <br /> WELL REPLACEMENT n DESTAUCTION at of d#rvlce well p <br /> PUMP INSTALLATION G SYSTEM REPAIR G <br /> OISTANCE TO NEAREST; SEPTIC LANK OTHFR O Ro01wr1n1 wall L7 <br /> FOUNDATION AGq CULTURE WELL DISPOSAL FLD. PROP. LINE <br /> IN 7ENGE0 VSE TYPE OF WELL OTMEA WELL PIT&/SUMPS <br /> L1 Inouill.a PROELFMAAEA CONSTRUCTION SPFCiFiCAirON3 <br /> 0 Opan Bottom D Menwi Dia. of Well Eagevllan <br /> CI OortwukrPrivay 1 Gnat PicK Die, of Woo Casing <br /> D The <br /> I'I Pdak Y Tyty Of Casing <br /> Ll Omar I n Delta SadlkltbnE�_ <br /> I luiwawn Depth 01 Grow Sul <br /> —_ Apo!ot. 04pIn I I Eanpe 6wdAC# Saul Installed Type of CrOut��^ \ <br /> Ae Well <br /> Work Dona U Typo of ►Nmp _ �' <br /> Wdl D#uroctlan Y M,F. Eula Work Dona — <br /> } W#n Dia lata 1�f aallnli Material 1 Depth 1 <br /> / I <br /> TYPE OF SEPTIC Dcoth Tiller Materiel. 1 Depth a <br /> WORK; NEW IN$TALlAT10N t I REPAIR/A001T10N I I DESTRUCTION 1 I INo IepIIC Iyt1aT Wool.) w a' <br /> Inns n will "Nt: Retioonu available within 200 ool.) a •c tower h <br /> �-- Commarcw ONu <br /> Numb#r of Writ whir. Number of Ded,eoms <br /> Character of soft to a depth of 3 fist: <br /> 30TIC TANK G T"/d Ig Water table depth__ <br /> PKG. TREATMENT PLT. LlI Cspocny No. computmema ( <br /> Dists4to to Merest: Wall Method of Dispoea �i �''1 <br /> ioundnlon Property Lin{ <br /> LEACHING LINE No. i Length of Pnrt <br /> FILTER !ED 0 Onten To171 IinglA/Iltl <br /> Fa to MI•Nc WNI Foundation Hap{rlt, LIM <br /> SELPAGE PIT& N A_.1-I Oepthl SI7a <br /> RUMPS Y 1 1 f7iwnea to hashes: ,yap Numtw <br /> DISPOSAL PONDS p Foundation Property Lina <br /> I heraby Cindy INt I have p•#wred�IN{ application end that IM wort will of dons In aceordence with SM Jolpuln gpunt <br /> rules and regulation, of IM an Jo#Cuin Cmo&y <br /> Home owner or licensed age nI'a 0 „ M Y Ordinances. qeb (ewe, end <br /> #Moloy any person In#uc agMlull dertn In# following: 1 cetyl that In Inc porlormanu of the work for which IAL r <br /> cerilliet in# tonowi Ipn h hienMr aF to become wbree, Io wdrkm#n's compansedon laws of ancsCoillOf Cork lar h chhirt P4 mit i►Issued, 1 than nor <br /> non laws of Cellforhi..••I Conify Nat in IM performance of the work for whian Inil,permit 11 i{euw,I ahaB empby Persons I singer l0 workmon 1 compenu• <br /> The {pMkant mu{t G#II for ail requui0 mapec ono. CaoWate drawln0/an ravers# side, <br /> —P fi,pned l�y _2. <br /> Tit11: <br /> —� 7� ��a•n/ /�O —ice_ Oats: <br /> I <br /> FOR DEPARTMENT USE ONLY <br /> ADpliOr CoAccepted by <br /> Pit <br /> Ph « Clout Imac,bny Datt— /LZ `I3 Am <br /> DY <br /> Dno 'Z''9-gj FIMI Inspection by �f <br /> AdJltlonal Commenlr. Dal e2' /- -3 <br /> applicant - Return all cooled to; Bad Jot uia Count Public <br /> I is yl roe ental tleelcp Darmie/5arrl aeavioae <br /> 146 R Jtd JQadU ie, P 0 Dox 9000, titan, CA 05201 <br /> INFO AMOUNT OU( AMOUNT AjAA: 1 11 �- <br /> • In ,>•7r,etY ,r. doCASN RCEFIVLD lY <br /> It 'Q OATF PERMIT No, <br /> a,..sa ied Into <br /> i f�� -12- 93 93-105 <br />