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1,11'A'1'IUN 3
<br /> ;;AN JOAQUIN CUIINTY 1111131.1C 11F.A1.1 It I !�J
<br /> ENVI1((1NMENTA1, 11F:ALT11 DIVI tl }�
<br /> 445 N :;AN JOAQU 1 N, {'HONE (209 416A.
<br /> P U BOX 2009, :;T(WKTON, CA 992FM �<r �
<br /> lit;Km.1T EX�>�i�,_;��_ Yl;�li n 1� f
<br /> (t',.m11 l,•t•• :n I rlpllc•rt ) r //// /
<br /> Appltcetl,•n :s ter•ty ende to fan ;naquln County •,:r a i,.r•c:' •••tact ani. r �JL♦� ties rfY(1(eMa/fr•+�rfn-d "•fa
<br /> applieattnn to awd• 1n -44,114tenew with Ban Joaquin I'rvnty •:run: N S.9 an o-T� t.
<br /> Jtfaquln County ILh:lr Mea:t.h S.ryire•,
<br /> 20326 E. Brandt_Pd._ Lodi _ 1..t SI:e+Acretrrt•-
<br /> ,c Aen•ess -
<br /> Saul Estrada ,, 20326 E. Brandt Rd. __- Pho^• __-
<br /> 0--nwa Name -- --- - --'- - '-- -
<br /> Cont•actopury, anc.p_Qrillers,lmill,eit P. O. Box 64,ldnden L,Ce^u N� 377923P••one -8a7=31:i4 —
<br /> TYPE OF WELL PUMP NEW WELL .+til 11[�tALt .tt'r' DESTRUCTION Xout of Service we.1 LI
<br /> ---- -
<br /> PUMP INSTALLATION Sy;Tf!• +IP4.R OTHER � Monitorlrs eel. (7
<br /> '�
<br /> DISTANCE TO NEAREST SEPTIC TANK SEWER LINES DISPOSAL FLD _ PROP LINE
<br /> (�.
<br /> - - FOUNDATION AGRICULTURE KEl LOTHER WELL---- PITS/SUMPS `lU
<br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUrT'ON SPECIFICATIONS_ V.)
<br /> Industr,el ---- [: Open Ronom ;1 Manteca — D•A of We F■Covannn - Dy o1 weu Cas,ng
<br /> Oom• It Private C'. Gravel Pad ! Tracy T.W of Caa,^g -- _ -- Sp•uhcahons
<br /> . th O'c•,n-o Seal __--- TyM of Grout
<br /> PrrD„c O;n•r t ' Dena O p --'-- ,
<br /> l..yoa..on Aolvo. Depth i Eastern S„.face Ser1 Installed M --
<br /> Repa.r Wora Do” Type of Pump _ _.. 't P Slate Wort Done &QtZ)Qy,d 1 cwt toot holo
<br /> Material i Depth _
<br /> esti t)r,snucno^ wen O,arrletp .------- V
<br /> DepthFiller Material t, nepth `'
<br /> lyPf of SEPT.f, wURK NfW INSTAL LATIQ`. -- NEi`AIR ADUITI-I f�f SIRlICT1ON I a,ISeol yySVSVQ (10',ret lied 1f wlb#.0 ~tea �a
<br /> Ineu•etwn r..n NM Res,eence _ Comma c,ae _. l;ur -- _._-_ - 1_•
<br /> NumWw of hv,ng units -- Number of be&ooms t
<br /> Character of$n o to a depth of 1 het Water table depth
<br /> SEPTIC TANK O TyM,mog ----- ---- Cat+ac'tL. _ No. Compartments
<br /> PKG. TREATMENT PLT fl Method of Deposal
<br /> De!ance to nearest Welt ..._v_ Fo,ndabon
<br /> LEACHING LINE ' No 8 Length of tinea_--- __ .. ._-.__._ Tote,lengl^!to-so _ --- --
<br /> FILTER RCD f.1 D'stanee to newest. well----- Fnv uaTwn _- ---- P,openv L,ne
<br /> SEEPAGE PITS — i i Depth __ ---S-" -- -- - - Number — - ----—---
<br /> SUM►S l, D.slance to f4weaf Was-__ Fmtndat nn _ —.--_ P,rpeny l,ne -_._—
<br /> DISPOSAL PONDS ❑
<br /> I M,reby candy that 1 have p,eDawed the apphtstwn and that the#rot► wJi to n.)ne In accordance Wdh San Jo.qutn county Old,nancosstate laws. and
<br /> rules and regutal ons of the 541 JOWu- County
<br /> Nome owner M Incensed apanl a signature cwod,ea the loanw•nCOM
<br /> IV I te •.that•n the pa.formence of tM wort lot which ones Perm,l a Issued. I shall not
<br /> entplpy any parson In such manrw as to become subte,.'t to wo,k-en a compensat,nn laws of Cel,fOfn,a Contractor's hiring or Wb COmtacitng apnetwe
<br /> cend.es the foaow,n9 I cenity that In IM pewlowmence of In*xor►to,ww,ch this Ve•'n,t 4(awed I shall f mpioy Persons aublect to workman s compen"
<br /> iron lams of Cal,to.^•a"
<br /> The acam m t call for of , sp•ctrir,a COmplel•Jra-Ing n..re.•,se a"V
<br /> S,gnedIt' � _ u'i-_- T,r.a .. .�_ Date -- tea -- --
<br /> FOR DEPARTMENT USE ONLY ` �Q
<br /> AppaKweon Accepted her 1. '��- - _.__ ._ Data -I_/a1./,-0 A���1/` `3' Arg
<br /> Ph of�In•gec iron tY IW .� �`�----_ Date_- _ F.nej Inspec bOn DY.w�—• -_ - Oates
<br /> Addtlronol Comrwe,.ts _ L_._CQMeD{.—f h Oto '_^_ .._ .,.._.. `--
<br /> Apo It. .nt 14.tell all retJ,•agrtin I Int) P.:nll 11•.I•h :,,•t.l•,-•,
<br /> tnvtr.•msnntot Rnalth Pnr•,t9,;1wrv%rna
<br /> ��• 4.1R N r r
<br /> .`•1 _ ____ .- Tom. -.-._. __ _ _ ^_ -'7�''� —_
<br /> ♦ AMOVNT At M,y110 �K T �REChYfO fly I pATt PFRM,T NO
<br /> r T AM0,1N �Mf � cASu --�-- I
<br /> I tif0 1r
<br /> �3+1•.� Vit•: s aEf�E:i� -,a ;'r'�t•C?i :i
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