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SAN MAOUIN COUNITY PURLIC TIEXLTI;1 4RVICF,"; <br /> 1-N','1R0,%,%,IEti'TALIIFj%,LTTID]ViS. .0 <br /> AN b <br /> 415N SAN JOAQUIN,PHONr-(209)469.3420 <br /> P 0 BOX STOCKTO N.CA 95201-039q <br /> YAW <br /> P�FIMIT KXPTRF:,� I YEAR FROM DATE 1,5�UED <br /> F <br /> T. <br /> (Complete in Triplicate) <br /> -.1 dcv,"Tbril This 2PPItC2110'r 11,M36:in cwr ance vvith San <br /> ;kn <br /> Application jN heriby m n!y ILI] !jy con pn.t!a�l the work t.'iei in Cclu tv Pum pit <br /> o;of 52n Inaziu I ic f(it2lth Semices. <br /> Joaquin Counzy Development Tillc SrcTiurt J-1 ;0 3 a,,,'Scz'�i­Q-!11 5-.�and;he Rule%3-d R,gu!;itior If '1,C) - "r <br /> 1C;4 (I Fo <br /> Jot AdtViiis 5 <br /> L_S� y Lot size <br /> Wk'571- <br /> Ow�F's Name &djress phone <br /> NEW WELL WELLAEPLACEMCNT DESTRUCTION L7.Out of Servlc <br /> Wall 0 <br /> TYPE OF WELLIPUM PUMP INSTALLATION SYSTEM.FIEPA:F; OTHER Ci moinitoritig well 0 <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER L;NES — DISPOSAL FLD.— PROP.LINE <br /> FOUNDATION AGRICULTURE WEt L _ OT)qER WELL— PITS/SUMPS <br /> INTENDED USE TYPE OF WEL PROBLEM AREA CONSTRUCTION SPECIFICATIONS L <br /> [I;ndustrial 0 Open Bottom Manteca <br /> Dig of vpoll Elcovation Die.of Wall Casing <br /> C" <br /> 1)Corriestir i Private 0 Grave;Pack 7. Tracy T>pa of CA3.Ag.___ <br /> Spre:beatrona_ --- <br /> Ptiblic; -1 Dew DePI71 of GFOUI Seal Type of <br /> Grout G <br /> S.rface Seul Install-d by I Aorox. Depth Eastern <br /> Repair Work Done (_1 Type of Pump "-p Stale Work OcReatEftert- <br /> Sealing Vaterial Depth �0 <br /> Well Destruction 0 wall Dismatot Filler Material Depth 8 jqQ4 <br /> Depth— — I <br /> TYPE OF SCPTIC WORK'. NEW INSTALLATION!41- REPAIRIADDITInN DESTRUCTION I I ft why partAl"A of pq'W'C"Weir is L <br /> vqm "454VIC"C!; <br /> L <br /> installation will ea": 11114sidiincs Commercial HEALTH <br /> Numbett,at 6ving until:__Z__ Number of D*d?ooms <br /> Chlivaclot Of*oil to a depth of 3 test: Ayr, e�� Water libbild depth <br /> Z4 <br /> 0" Typelvill'o --ff-t-r, or Capacity fe;!�)C'C—LL No.CompainirnItAtt <br /> SEPTIC TANK <br /> a PI(G,TREATMENT PLT.0 Method of Disposal <br /> Well >//In FoundationProperty Lim <br /> Distance to nearest: <br /> Total lanolhIsile <br /> LEACHING LINE No.&Length at h"os 121 <br /> W founcavon Property Line.> <br /> FILTER BED Distance(a all_r_ <br /> -Depth ,2iSize Number <br /> SEEPAGE PITS <br /> SUMPS LI DISLamcd TO nearest: Well X/dO' Foundation /,'T` Property Line <br /> DtSPOSAL.PONDS <br /> n accordance with.Son Jo&CTuin county oidirvances vots,laws.and <br /> I))srsby comfy that t have Prepared this appl�cnjion and Me woel,w,U be done i <br /> fF rules and regulations of the Son Joaquin Cauatty <br /> HC-nd owmir or licensed agent's signature carlds$the lotlovv,nQ:"I certify that in the pailormanco a,'the work far which this patTrikj is issued.I shan not: <br /> 1 to became iublact to woArridn's componsialion Iowa of California-"Contractor's hiring at tub�coniractinq signature <br /> employ any person in each marine,as work for which this permit is issued,i"it orliPloy persons subject to workman a corinpainw.. <br /> certifies.The following�"I corfily that in the performance of the <br /> lion lawn of Californilit <br /> The applicant must Call Jar all r&qui.-od incitioCliOnSr Complete drawing on r"ar"s,de. <br /> Signed Till Date: <br /> y <br /> O-A\C�� F013 DEPARTMENT USE ONLY <br /> _ EV31- <br /> 13Y <br /> C_ 10- K Date A At a <br /> Aiv- <br /> Application Accoolod j F <br /> Pit or Grout Inaloettlion by Date Final In$PAclion b y X <br /> Additional COmA*nts: <br /> Aprltc&nt Return all cop!es to: San Joaquin County Public Ilelhh Sctvkcs <br /> Envilonnlerilzl <br /> 445 N.Son Joaquin,P.O.Box 389,Stockton.CA 95201-0388 <br /> AMOUNT OttE AMOUNT REMITTED AS RECEIVED By DATE PERMIT NO. <br /> INFO ' <br /> -77 <br />