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{�-,d .JO QUIN COUNTY PUBLIC IIEi1J..'IIE
<br /> fiNVt}tON4[£�T,SL I[Eir1J:EIE [)IViSION
<br /> '.15 N SAN .JOAQUIN, I'IfON'r' f2n�}•ifi}i-:3•:::(1
<br /> P O 13OX 201A)• STOC KTON• CA 95201
<br /> i'F:E{14!IT EiX1?[IEJ: ifE.;AH E'E+t)3T I)ATSI=iisU�T;U
<br /> Application :a r.-rev r ,ir ^wa ,:. .r. ...:.•-y r .. .•rz. - .. - .n'n:. v -I•'• r:.••..
<br /> *"Itcatton :a maid.^I, mor-�.:7er.,: V. r:iwr. �•
<br /> .0"'Jin eeunty Public Health 5ervscae.-
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<br /> .fob Add,ess .',f _... ... ... - C S r'C 1 r!:. - -. _.:a,. .. •n,c•• -
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<br /> y L f:r.l tJ 'll" „.as ! - �� I�' j / - .v }'?a:.--- - P�n•�a J-4�__ t-
<br /> Owner's Neya _- S` ..-_____,.�_..,___.r__. •.' .. -. .. -. - » ?C_� ��I��Y///((Ii
<br /> cant'a•I,r_f'�''if „1 .'�.,,,�_ �;,.• , � r',...i : t _ �'.i,t��-- -_ �
<br /> TYPE OF VrEt L,PUMP •:E:V 4':ELL 1C: - - �`t-L, 'tt°••-- ",'• :Pil_:s�1S' cot o' :errs ce we ..-
<br /> vonttertrg Vel: Ei
<br /> a�11.
<br /> PUMP 4NSTAtCATI(%, �: S'., s. OTrIER I. t
<br /> DISTANCE TO 14EARFSY: SEPTIC TANk --��'+ SEWEP W ES ....�--�.'C -. D'S'(!"`L FLD PROP LI'4E .-�_"'
<br /> ----- FOUNDATION_. =5 =:.._.A GRrrtrtTURL V:I LL.-----_..t';-'..ER V.Ekt-ter— PITS I SUMPS
<br /> MTE�:DED USE TYPE OF WELL PROBLFM AREA CO>a5Tgtf-TtO!..SPkCIFI�ATIOt:S
<br /> Indust:w --_— C.,`Open Bottom i Manroca DIA of V:ea E•cn,aoon��= DIa. 01 Well Casing -
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<br /> Camesrc Pn.are L.: G-J",Pati ! Traty Ts've of r;as . . (r_1 Spec.11cat pns
<br /> i'I Public ''Gtfwr I'7 Det:o Den:n of G,nur Seal __.. - -;rt._'____- Type of Gloua tT�Q•
<br /> I 1 In IV..tlon � �_ AVIu o+ Oeprn I I Eastam Surface SeJI In Y:n1106 by
<br /> Iaenalr NJOH Done E.i Type of Pump 11 P_ . ��----------- State V.,wx Done
<br /> E •Neu Destructor. weft Oiame!er Seellag sate r:al L IrP:r.
<br /> __
<br />` Depth �__ Falrr !tnterShi
<br /> TYPE OF SEPTIC WORK. NEW INSTALLATION I+ fi{PAIR-ADDr TION - C•E5TrttiCTIOI4 14.,srprlc%,stern permitted if pub:-c sewer•a `1`'
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<br /> avaaab.e w,Inln 2CO icet.l '�,
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<br /> _ InstausGon will-tilrve Res+dente_ Conrneraa!-_._ Orhnr
<br /> E - tJumbar of ling wets;_ Numher of bAe�opms.--___
<br /> .-. 'Cha,actet of soil to a depth of 3 feet: +,net table depth -
<br /> SEPTIC TANK O TypilW19 _— - -Capac�:y_— No.Compartr,en!s _ 1
<br /> PKG.TREATMENT PLT.❑ Method o1 D-sposal
<br /> Distance to nearest: Well Founduhoq Pfoperty L'"
<br /> LkACi-tING LINE 0 Ne.d Length of!,nes
<br /> FILTER BED CI Distance to nearest. Well _ FounddhOA — Proprnv One
<br /> SEEPAGE PITS _ I I Dep;fi _ S+ve NumL-er
<br /> SUMPS U Dislence to nearest: V1ell_- Foundaton - Proper.,,Lina !\
<br /> DISPOSAL PONDS C:
<br /> I hareby ce'rtdv that i here P+epa.ed this appltcaucin and that the-ors wdi be no,-u in accnidence-in San Joaquin county ordinances, stela laws, and
<br /> rules and regulations of the San Joaquin Cottaty -
<br /> kpTe owner or Iltansed agent's Signa:we certifies the Icllowing "I Cbrt'ly thal!n the"riounanta or the wort 1al w9r,Ch Ihis:.ermit is Issued,1 shall not
<br /> employ any persor,in such manner es to becoma subject to wwlkman on
<br /> s COmp5at.Vn TA+%01 Celdprn�a I Cnnl•acta%S hiring or sub-coniracnnq s:gr+ature
<br /> candies the lotto wv q:"I Certify that in the perlaimance o1 rhe Wolk for,.h,ch Ih,S porm.!,issued.I snail employ persona subject 1n workman's comi;kens3-
<br /> lion taws of Cahforrye:.Y_.. - -
<br /> The apoticant must call rpt all requ'red inspections. Complete dlawlnd rovaisp s,da
<br /> iurdX� Date:
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<br /> FOR DEPARTMENT-USE ONLY
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<br /> Appficar •� .� n Dare-_� Q .
<br /> tlon Accepted by
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<br /> ll t IL1�.I�u Date_I/� �� Flnst Insy:cton by�, � Dara ,
<br /> Pit or•�/puvtl intpeCfipn by
<br /> Additional r
<br /> omentt- .' i i�,.• -
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<br /> ,turn- Rturn alt rr•nI PP tn: Sen .1 c•n.fuln (•rn.r•ry I'.-'-I t,. !1••nl th
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<br /> nvtry: mn
<br /> m � tat k!•a •h I•- $I1 .;1• .1 r .} n�
<br /> 4iS t: tiRn .1.;a.t"tn, i, rI Ii•,x •-••..t :,fin• !-p-•-5�!i•I 1
<br /> �AMOUNOUE IMOVNT RE Mfr�ED - HELE•.''tl air ATE PFRMIT NO. -
<br /> �FEE
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