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<br /> SAN OINT: IIIJIIIC M"ALTII :i FtV I(:E,;JL
<br /> FliV I RONIdENTAL ]IEA MI D I V I;iIl)ii ! a
<br /> •1,15 N SA%l .JOAQUIN'r P110 E (20(3)468-3420 11 .0 ISOX 2006, STOCKTON, CA 95203
<br /> .l.
<br /> .>I.ItIIIT UPI It P11, fFA;__ 1W9 DAI'f.'
<br /> y��C ; j('p421.,!
<br /> lrstwllthe vcrk herr:,; dcecrtb:d- Thls
<br /> __Aryl Stti!Son fa hrrety'malt to Sr .'cwyu r county t",--?! •:, s r`..c- ".._ .1.02 an4 t9e 3n`ee enc `tr.rtulAtions or 5an
<br /> mode In CB�,ISenct vi:.`. :Ie r. �•a•;u:r. ty _ .:•n::-r 't .'•i • - _
<br /> ayplitr,Cc- Ss _
<br /> -doaquln Cauttty PvoL'^_ Rcalth 3err2 crs. -7
<br /> r . ;:ter?A:r•ru!r y �J !F�}.
<br /> - ,lob Address
<br />` � !T-TL i<1�'�' .L.S.���:`__�f_`L._,.- .-.'.a•rc:/i'lnC!-�TC/1{rte...-._ -_. .�r-. ."---..-- o one
<br /> Owner's Name (�/r,, �f� I
<br /> Iy"(i( �J.1k;,,--A6 k�,J CJ _..�_..r'sr -1 46TAI,Z� P*ont
<br /> Cant actor rr�f t - h.an•;i-1�J
<br /> -- R Ri1CT:ON i�Out of Serrlce Well
<br /> NE'A WELL .' 1•.ELL E taanitorinb Ye11 C7
<br /> TYPE OF WE111PUMP- _ SYSTEM' REPAIR L� OTHER C5
<br /> PUMP INZ,A LATGnN fl PROP. LINE {
<br /> - r TANK f4' 5'EvrER L1'1E5 �t�rl_--- DISYOSAt FLD����������
<br /> - - - DISTANCE TO NEA REST:'SEPTI. -?.GRtCULT;;RE .-YELL _ _ OTHER WELL etc PITSISUMPS
<br /> FOUL.OATION .._--�_�
<br /> TYPE OK WELL ?ROFLEM AaEA 4.ONST RUf.T10ty SPECtFICATIONS r -
<br /> IN7ENOED USE _ --_ ------.._. ---.- -- - ��+� Ou.ei Well Cotr.q
<br /> Ci Manteca U.A of Well E•Cevelyq /�..--- -
<br /> ('1 Industial Cl Own t101tom TYYYY/ Specd,ca+wns
<br /> �/� �Vzfs,.el Pack. T+acv TVCs of t.:as,na _..��-•--
<br /> V""ameal,[lPrrvate /� [ype of.Grow
<br /> 4'Delia Death al Grout Sel.d41 A -
<br /> - - I'I Prrtuit !! �
<br /> 1 t Init}ar.d! +Z`�U Appas. Capth '. I Eaaleln Su.ace Se.1 Inst Ntrd \�
<br /> T OE Pump H P. _-_,Stale Wo+>' Sone .
<br /> . Repair W'o,k Done Type Se.11ru1 N.terlal a Deyth -�
<br /> Wait Destruction C Won D.amater -" riller HAceri.l A Deptt:
<br /> Deplt
<br /> TYPE OF SEPTIC WORK' t+EW INSTALLATION I I REPAIRrA1:G1T10N; C.L5TRL:C1>s/rl' ava,l Ole111.,12 r1w ton 200 rest'�ed d p.lbhc sewer n
<br /> s
<br /> 1_1anation in aer e; Residence __ Commerael_-_ Other
<br /> Number 01 Innnp units;�- Number_of t4JIOO`ns_—_.� - -
<br /> - - Water taDla depth
<br /> ar
<br /> Chi'cter.of sol to Y dspth of 3 f«I: -
<br /> Capac,ty— 'SrO Cornpartmeraa
<br /> _H
<br /> SEPTIC TANK - - Q .TypelMfp ... - - Method of Disposal
<br /> PKG.TREATMENT PLT.Cf props ty Line
<br /> V.�:t Foundet,an-
<br /> Oistence to raarect:
<br /> Toa �e�ptfilve _
<br /> - -LEACHING LINE. -Ll No.6 Lenpth of fine —_—..------- •---- PronerSY Ltns l -
<br /> FILTER 9E0 G Oistanca to nearer:: well
<br /> Found.4or, - t
<br /> Number
<br /> SEEPAGE PITS I I Depth
<br /> Sae— ---_..
<br /> SUMPS
<br /> LI DistanCs to nearast: Well�_-� Foundat.on- Property Line
<br /> DISPOSAL PONDS ❑
<br /> cc o,d
<br /> Ihs+lby Nrtdy That I hob-PrlOated,l hi%epPhtahon and)oat ru
<br /> Ine walk w,1!'re dun.-n eance wun San Jaaquln Coun15'O+p,nan[ef.flats 4ws.-a
<br /> r ulat,onf of 114 San JoaCuin County � w rl ,talents of It"work for wh¢h Ih.s Dernal is rssued,I:hall not
<br /> runts and sp
<br /> F-tome owner er!;tensed apeni'a opnew<e a,rtAb1 the fonow�.•+p."I cert.o shat,n t.a pa o
<br /> - in such manner-es 70 decwris wbpcl to wor�."',e al's tamps nsal�an laws aLCALtornH,"Cpm attar's hlrinp or yuo contracting II;Qnatss,e
<br /> n eon 1!hail employ persons subiect to wo+tman's compents
<br /> employ any Per
<br /> i Certdga 1ha taaawirp:"I Certify that rri 1M perfarrnanu Of the wb!a for which this permit t7 issued, F
<br /> Ilan taw-of Cefilorn4-•
<br /> -- The applicantst call fat ail re4uirad inspections. Cemvinta("wing an reverse srde- - �/ 3
<br /> 1 f y vL Title:
<br /> signed
<br /> FOR DEPARTMENT USE ONLY �� �_IP -
<br /> Dale -: -= ..Y--- Ana -L-- +a-..+ .
<br /> len Ate ted by ^" .
<br /> Applicet ►P -
<br /> '1
<br /> De
<br /> F,nsl Inspection Ac s
<br />' Pd Grou Inspection by 1 .!1! —
<br /> _ Additional Com-nts: . -
<br /> Ira to: Sen Jna,iuln Cnt,nty ruhlle R,•slth tie-n•L�vv -•-U��` '�
<br /> AppI EC°alt Return 411 cop Hal.,tnvvsant.1 ll._.Ich Prrrnl t/tiervlcrn -
<br /> 445 N ;an dorsa fall P C
<br /> 1 Ro- 200V Nthn, CA
<br /> �r ,� L 1
<br /> - - 0.MIl'NO.
<br /> NF
<br /> - CK R[C[Iv[p Qv 'OATF P[
<br /> REM1`"tED
<br /> FEE AMOUNT DUE AMOUNT - LAS„ � -
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