|
r
<br /> ,1131iL,ICA'I'lON
<br /> SAN .IQA IJ 1 N l:UUNTY E 17131,1 C HEALT11 1 c S -1 P �
<br /> FNV f RONMENTAI, 11LALTH DI V.I S I,M :4
<br /> 4,1:1 N SAN .JOAQUI N, PHONE (209)4663 do ����
<br /> P o UOX 2009, STOCKTON, CA —
<br /> IIr u
<br /> PERMIT EXPIRES L YI':AR FROM DATE �1^T--
<br /> i
<br /> App'lieatlon in hereby laude to Fen J•:w.luir .".;u::eF !_: n n cr,.�•r ..t .ai:J:rr !ra:.a11 the vark t:err:r, d••srrlh^d. -'tue -
<br /> appiiCAt.lOn ie dedc Sn coyll:,nncc v,,,!I Set: J_„,u!n cc-az'ty';. .:r:e t;c c^N::.`L n::d 1?'u. end the Yu lee and Nexji il,nn of 5wn
<br /> Joaquin County Nfanc Y.eelbh Scrvlcen.
<br /> ,;r..„p
<br /> Job Add,ess --------
<br /> �.�.��.��”--- .._L1.`i•.-..moi �.,Y' .... !f.r1 c_ �_ i...t . ,' -�-__....fes�:'-
<br /> i
<br /> OWnO!s Name _
<br /> C 0n1taClpr.-y_.. L��r. -r!If= - .,-:'c•. 1" L-_ _1�.e- ;!. :.�� � ,i•se e j�_.J.cz_Y''r'^P�.,:.a�:r_.y. l...'Y
<br /> TYPE OF WELL;PUMP ?,IEN4:FLI, •'.EL, :'i;'!'„-I f, 15..f.fC"ic,4 Out of Service well
<br /> ---._-_-_.-_—.
<br /> PUMP IN°iTALLA7ICffP
<br /> Nor,ltoring well 11,1
<br /> DISTANCE TO NEAkST: SEPTIC TANK SwrFP S"::.�y .. .. _ '?otiPQSAI fL _....._-- PROP LINE
<br /> FOUNDATION ---------..(;IIICL'i._L%RE`.'.EI-�--_=_:..r___-11ER Y_EIL..._.-'----- PITSi UMPS
<br /> INTENDEf1'1S£ TYPE Of 41FL. PRO61F.MARf.A CL 'STRUCTl0N SPE r IC_AT!GNS
<br /> Intluslrrel _-- ;! DpeR RUflnm. , j•�d•,INfd l)d ,.YI L•lgll Erf.avdl,pn _.._ fila Ill Well casing __.___-.,- I ��
<br /> CdS,nfj
<br /> F!Domestic/Private i-i Gravel Pack ` Tratype of SpeclhCal,onscy - -- ------ `�,_.,�- n
<br /> I''PrIhliC I; Othe- T p,:f:,, Prprh col Grout ?edl _ _-__._.__.._.-_.._- Nfi�_I ��,,
<br /> it I,ngauon _.__ Approve. TDnpt" i Edslen, S,.rldce
<br /> Repair Won Done a TYPr'of Pump �._-_ 'f P.,. _.__�,--.-.-- ....._.� Siete Work Done
<br /> SealSag Fla:e-lel 8 L'epth 1 t11
<br /> -. Well DestruChorf ❑ Wall-Mameler -
<br /> Depth Fliler t4a terinl a D-pth - �-,
<br /> TYPE OF SEPTIC WORK, NEW INST A[.LA f IU':' i H{.f+tiIA;ADDI P:)Pi)< 1'I,S I FI L;C T WN I I INo sup trc C1I, 4e Ff�r�14t�,e1/+i,r'eR re
<br /> availably, ' l
<br /> Initatlahon will serve: Residence_._.. Co-n,trc,al
<br /> Number of Atving un,ls:. fdumb(11 of bedrooms Wit labia depth
<br /> Character of soil to a depth of 3 lees .- --__.---1J..�.f;.I:_.I___._.-_-.---......_..---_-- --^-^---- '
<br /> SEPTIC TANK C) Type/Mfg .-..____..-_.-..-.-.___..-'--- Cel+acdy-__----_� No. CnmDarimeinis
<br /> PKG. TREATMENT PLT.C; Meinod of Disposal
<br /> Dislance to nearest. "Jell _--___..-- Founda Uon_._---'--_-.' Property Line -
<br /> No. 5 Lcn th of Tinesfr f Taal Inn
<br /> LEACHING LINE f�( g ----'---•R-�".....�..-1.�.....__..------'-- 4 ..—____.__._ `•. ,
<br /> FILTER BED 1 I Distance to neared. 14'„11 ll.%+�F'ni,�,ad hon__.---___.._._ Properly 1-me
<br /> SEEPAGE PITS --11 Depth
<br /> SUMPS 4.i D,slan•:e to nearesr. Well Fuunda Pon .-._.- -- PtotlertY tine -- -
<br /> DISPOSAL PONDS Cl
<br /> I hereby certify that I have Prepared 111+5 dpphcanon and rhdl[+rd wot' .vdl be dune it,ac[ormnce wren San Joaquin county ord,nancas- sleie laws. Ano
<br /> rules and rsgulat,ons of tha Ser,Joaquin County
<br /> Home owns,of licen5od agent's signature cerldle5 the lollow,np, "I,artily[bar,n the petlorrnance 01 The v.urk for wh.Ch th,s pal"I,s surd.I shsll no,
<br /> employ any poison,n suer m'nner as to betoenn subject to wrakr,ran's c.umrensahon laws of Crlifoin,e_'Coniracior's hiring or sub contracting signature i
<br /> Certifies the Idflowing:"f Cartt1Y Chet In the perfOrmenca of rile won,lot wh,cn this permit Is nauad.I shall employ persona subject to workman's compenas rl
<br /> Pion laws of Celilornie.”
<br /> The applicant must Cali for all fpqudec inspections. Coml.letc, 0—Ing On tavwis side,
<br /> Sipned
<br /> FOA DEPARTMENT USE ONLY
<br /> �_ _ _ Dale ..._
<br /> Appliralion AccaFmtl by �----� --���.._..__-�_-.--.---.--� � A7ck
<br /> jfv /v1�
<br /> Pit or Grout Inspection.byinapeCtlon by
<br /> ,�+
<br /> Additional Cornrronla.-
<br /> dpYl i,.nor - itnturn al! -„;,Ir., tt:� Sun Jn::,l'jr, uno, !,,:,- 1!•,nit” 5••rrf r,.
<br /> f:nvf ronmrnt-, FF�nilh !'••rna t!• :r,l rr:.
<br /> ll .'f •,!S:h, „ .I lrns ..'1+l! Srhn, d 1;.'•3n!
<br /> FEE AMOUNT LIVE AM6UNT Af A11F11C HECFIvt6 gv I DATEPfPAII! NI;
<br /> NFP
<br /> I Z�� (} —
<br /> 1-941 �,� l
<br />
|