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APPLI('AT I ON -
<br /> SAN .IUAQliI:'I COUNTY 1'UI3L7C: 1[i:AI: I
<br /> ENVIRONMENTAL 1IP.A1.7, I )IJ' � I
<br /> 145 N SAN JOAQUIN, NIONI: (209
<br /> I) 0 BOX 2099, :37`0C'KTON, CA
<br /> ltllht,T F:7(I'IltEN ' F.AIt FROM- DA 'r•
<br /> in FriplicaC l
<br /> •ApplleeLiar' to hereby mC_ a F r. .rwqu:.. rcr s ._"it .rut: n. a all _rt heref- described. This .
<br /> APPl1"t,Ion !e mad- In etur{,lienee v.tb Join Jc•n,,+:a Ca::.-. � -.:non Ccs!%_. S=y ar- 1t02 end tirewRu:as and Peg•aiatlons or San
<br /> Joaquin County Public ResltC Sery:crn,
<br /> :ab Address __.-./ mss-.,���a._..l'�7r1 fC ��1.._ ..__'__ i:,;. . ill_!/(�`._ --_ a.. ...crrnr;c _�-�+[�1• I -
<br /> �,� / ..... I ,fI� ]
<br /> Owner s Eaan`,eJ�Jr' 1.-- \{� ili_ � �.C... Ad,tr:si rC 1_1. x_-•�-L�-L-_-f 17L..t.t�.k.Phone _L1 1�� ��
<br /> Conti ac to,._j,,f'•�(�LIjI ls0_.1�,_._ ..,:cos ��'_�_, �._: A_416-Ad "-s-�:t (lam _./.-JC= -
<br /> TYPE L;F WE.LLiPUMP NEW V:ELL ':VEIL: S:VLACFf:FNT 0£'S Fi,iCT,ON i;; 'Jut or Service 1:e11 •4+
<br /> - PUMP INSTALLATION-�, - SYS!F:'KCP4rq '_ OTHER yr Ma^.1 Loci ng Yell E-
<br /> DISTANCE 70 NEAREST: SEPTIC TANK.[ SE'.':ER ."NES ____.—.. ';. F-O. ._ PROP.LINO 1` -
<br /> f
<br /> FOUNDATION Af,,PICIiLTJE L•
<br /> piELr :t1.L.��_ PFTS/SUMPS ( -
<br /> --�..,..... GPI
<br /> INTENDED USE - TYPE OF WELL PROStEM;.PFA CO1•IS'RUCT!0!:SPE....ri a':ONS
<br /> i? Industnat f:Open Ro trim !tenh!ca D.a of Well E.;a�at,or �• _-� Dia. of Yell Casing
<br /> r "i 4 _
<br /> XDamestre/Pnvesr y Gravel Pack TraeV True C1 Ca„ng_ ..,.,.__,_ _ �.— Spec,bph «ons .aA•
<br /> I';PuDI'eer .' Drj!a L;cprt,of Elrnat deal -
<br /> I d Irrrgalwn .-)L-App,oz. Depth Ei East,m $„r!ece Sedl lnsea'Ied by
<br /> Repan Work Done i.i Type of Pump ---._.__ .µP. _ - -..--- ..___ Sta'a V;ork Dara
<br /> We[d Destruction ❑ Well Diameter .._ Seel'-LS Material t Cepth .
<br /> Depthfiller Matertel 4 Dipth
<br /> TYPE OF SEPTIC WORK. NEyy INSTALLAtION'u^14.1`40R'ADEPTI(N+ D'_S1it:1CTiON, ; Pic,septic sysiem perms+ed if p„bl,c sewer is
<br /> avaiiable within 700 feel.]
<br /> {�
<br /> tm:allat+on will terve' Feudence_ Co•nme:c'al __ 010•e,
<br /> Numbar of living units:_ Number n!bedrooms
<br /> Cheractar of sail to a depth al J 1ee1' --- Water table depth
<br /> SEPTIC TANK ❑ Type/Mfg —_ __— -._—_ Capaclry_ No. Compartments
<br /> PKG.TREATMENT PLT.0 Method of Disposal y
<br /> - Distance to nevest: Well Founde Yon Proemny Line
<br /> LEACHING LINE Ll Ne.b Length of lines .. _— ---- Total tengrrels'ze
<br /> FILTER BELS Ct Distance m neaia-1: War _-- Founaatwn ,— Proverty Line
<br /> SEEPAGE PITS 11 Depen
<br /> SUMPS - 1.1 Distance to'nnarest: Well Foundation _ Property Line - - -
<br /> DISPOSAL PONOS 0
<br /> I hs',;^.y cirtify that I have prepared this application and that the work 11 be Oahe in aCcnrodn[e with San Joaquin coonly ordinances.Aute laws,and - -
<br /> rules and fepulalw r,5 of 1144 San Joaqu•n County -
<br /> Home owner or licensad agent's s,ona,ure"rl,hes the following:"i comfy that rn the veric—encs o1 the work for.+t,ich this permit is issued,I}hall not
<br /> employ any person in such manner as to become subject to wohrnen's cG mpg nsa ooh laws�I Caldprn,a-'Contractor's hiring or sub-contracting signetVre
<br /> candws the following:"I certify Inst in the pGriormaPce of ine work for which ILtis permit is issued.I st'.all employ persnna sublecT to workman s compenta-
<br /> tion taw�5EIAJ
<br /> ”
<br /> The sppof&I!rrequced pec tions. Con-plale draw+" o eybyt�sa s�i. / -
<br /> Stonod <� TI:I nif� [k.� _ — Date:
<br /> FOR
<br /> 'D'EP MENT USE ONLY ��(��
<br /> Appl:cstrgn Accepted by r yi..�c �-1.- .......-_ .- 'Date� �79Area_,._r��,•�
<br /> it
<br /> Pit a�Grout nspection by —9r`-'— `^ _�1te Final Inspect.an by 6a[e -
<br /> AddrioMl CarnrrrnSs' Ott � ;LCL r f',.-!.'l�_ a r_L•
<br /> APS•1 Y,Writ - lie•I_u rn a[1 roti r•c tu; tion Jnagctln Cnunty Pub] C (1111(h S+-r
<br /> i ir••ti
<br /> h,nvin)nmcn La; m,alth 1-rmdtizervlce!,
<br /> •4f, jl :an ,,n;,q:LLn, f' t.1 Hna 29t?t{, Stkr.,
<br /> '�{f,., INFO - AMOWYT DUE AtrOUf+7 REM}T'.Eb ! RECEIvE^9Y BATF - PERMIT NO
<br /> I 3 �•' <'" CAS!• 1
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<br /> Eee,t t.n• +_.,� , C>�; (��73 r I3 5~`t 3 - j t�_5
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