Laserfiche WebLink
r <br /> 't� 5 <br /> t <br /> hPPLICATION FOR PPSRkIT <br /> lye <br /> 1 v <br /> SAN JOAQUIN COUNTY PUBLIC HEALTIi SERVICES <br /> ENVIRONMENTAL HEALTH TiIVISION <br /> _160I"E.- HAZSLTON_AVE.--,__PHONE 20 <br /> (209)968-34 <br /> I P U Box 2009, STOCKI CA 95201 -- -- _ _ <br /> s. <br /> r R R TE 10MM <br /> (Complete iti TrinTf, ate) <br /> y� <br /> -AppllcntloR 1a hereQ, tonAe to Se.n Joaquin Covnty for a pc.ru t to conr'.'::et nrdlor install the work herein described. This <br /> 1 1 application is -xrle in cbmylfanee vtth Ser J„Sa,:1R ccuatr ordinance No. S49 and 1862 end the liaise and Be <br /> dulwttone of Sen <br /> Joanutn Cowtt•- ?urilc Rea3th 9ervJcea. <br /> Cnv�C�G - j.ut t31r-c/Acrewte31 <br /> _ <br /> Job Address _4x <br /> -- <br /> Y <br /> Phone .- <br /> �� <br /> License No. iZ ptwne <br /> _ �? <br /> PEST RUCTION t✓WL OF service well L7 <br /> Contr3clgr •,ryELL REPtACEti7FNT 1=i <br /> Y=� -•^1"'"- - NEW WELL �I Y&nitarinf3 Well <br /> { i i'' TYPE OF 14cLL1't1�TP. gVSTEM REPAIR LL <br /> ATHEit ❑ <br /> PUMP INSTALLATION ^; DISAOSAL FLD. POOP,LINE ' <br /> SEWER LIVES PITSS/SUMS <br /> DISTANC5 TO NE,-REST: SEPTIC pGRfCULTURE WELL _ �T OTf4ER WELL_ �� <br /> n <br /> h FOUNOATION�� -- <br /> TYPE OI'WELL PROBLEM AREA CONSTRUCTION SPECIFIC:TION5 Oia.OI Walt Lasing, <br /> i INTENDED US.- -- Manteca Di+-of W'ex E,cavalian_ � <br /> «Ppsn tiol[em �-: SPecilicatiors, <br /> �4 `' { CI tndvsuial P Tracy Type of �- <br /> �t rte'` '"C1 DomasliCl Private a Gravel Pack Type of Grout _.-�� <br /> _ f 1 Pella Oeplh L Grow Seal '" <br /> !a OV,e• <br /> Public 5u,faca Seal Instanrd by --��'- <br /> APtraaglare.elep[h I I£ef:ernv.• <br /> H.P. <br /> Work Done <br /> Repair tR/OIII Done i.".• TYoe Of Pu'w . ct,r,lirA Material h Day th _ ,Y <br /> f Lie:Dia•nn[a, r <br /> Well Destruelion C t Tiller NAterial i Ewptl <br /> n ✓ - pet,lh ---�• %A <br /> ti- available w,thm 700 feet., <br /> > a TYfTIG ti4Ugr--�tiEW iN`+T AL LAIEON I I ftEPAIfi-•Ai)G!l1L'N Pt;i RUCT10N•I I INa 4st`t'C system perm,tF+ld,I gIbIK sewer n' <br /> �1 <br /> 3 k OF SL <br /> Other <br /> A lnatallel,on will serve: Fal,enc, J COrn,ne,c'0l f--/y <br /> Nuinbr of eJedrooms �a�+ �Wstsr tsNs depth r <br /> S.r NUrrlbar of living unit L:�� _��j ,, -- <br /> r* CMtacter of sail rn s depth or 3 leek. r Cer-acitYQ- No.COmPTA�^ente . <br /> ;. . G Type!Mtq �( <br /> SEPTIC TANK _ Me:hoJ a}Dispoal <br /> �xrr T <br /> U PKG. TREATMENT PLT.❑ Plopemy Line <br /> �i M Fow,tlnt,on <br /> �- - Disttlnca to nearrsl! Wall�L�' _ <br /> �]—._�.t�r�— — _ 'seal Ienglhl Nr+ <br /> .( No H Langlh oI Imea s �r PrtlPerSY Line ��'� <br /> . LEACHING LILAC /� ��. Foundation- �--�' -, <br /> I)isun[e w nearest: writ%. --'- _ <br /> :FILTER BED <br /> Number...^—�..�-�- - <br /> Srre - property line <br /> •, t s f - SEEPAGE PITS t I (;~,Pth ��.- Foundation <br /> - SJMPS F-1- Ostance to nearest: Well <br /> �,:' DEPOSAL PONDS IJ Us <br /> t hoieby family[tial f have P,ePe:ed!1»s appt,calian a Inst Ina waren ytrhat ro thanperformance O!t ha woJv Or IwR'Ch this INIM11 n Issued,1 el+all not <br /> rules and ra6u:etions of the San Joaa +n Catu,ty stwo <br /> Homa pwr-er m licensed agent's srgr,atwe cemilrea iiia foltOwlnd. 1 shall smpioY peraOns wbleft to wnrkRyn s eornpensa• <br /> emPIOY any Perron in s 4 care taste n the"r s 10 x1niwmubrecolt na`+am nig co c n�a perm o iuued Of itornia.' [ontuctors hiring Oi wacOntraCt;nq lige <br /> a ✓ <br /> �l r,r.. 1 families the tcslowinq <br /> N' 4. 1='.'tion laws yf Lalifprnia." me drawing on laverw side e� <br /> ' The aPPticar!:'vast tail lot all{aUuired ens>IectioM. i;ompl <br /> Date: <br /> t <br /> Signed �'- <br /> +, FOR DEPARTMENT USE ONLY <br /> Osu `� r Ara' <br /> �c`GLz f <br /> Maio 's O <br /> ApPlitalinr,Accapled_bV —T. Date Final Inspection by <br /> Pit t f Groat tnapa^.tion by <br /> Old rx, <br /> tFv r- a Additional Cammants: uiP Coua:Y Public Bealtb <br /> Applicant Return all COP1aa to: San Jces <br /> _ Services, DCo=ntarntsl Health Permit/$erylces CA 95201 <br /> 1601 F. 1'ALel'.on Ave., P 0 box 2()04• $LeCktOP• <br /> Y CK.7 RECEIVED By DATE PERM17 LA0.• <br /> ,� _ 1 ^� AMiOUNT kEMITTED Cp5,1 <br /> r - FF1 AM.JUNT DUE ��� <br /> - S/ <br /> c <br /> U <br /> c, i Fri am <br /> r 4� <br /> � t• <br /> f <br />