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JOAQUIN MUNTY PUBLIC IM1}_.7111 -,J;'i
<br /> ENV!R0NMKNTAL Hl"ALTH J)1VjL;1ON
<br /> 45 It'
<br /> - 5AS JOAQUIN, NIONE ("09),168-34LO
<br /> P 0 BOX Z'009, STOQKTON, Ch 95201
<br /> PERVIT-E-XPIRR'S I YEA11 !"POM DAv..' issun
<br /> A'VP I I cat I On to 1., 1" :lk:. t k
<br /> &PNICAtIOn 1.111 tAd- L.
<br /> *¢ �zuin Ccvnty Public
<br /> Job Admoss
<br /> -7 '4
<br /> C
<br /> LL
<br /> �F OF 7VEi,L,PU%,IP ;E,V WELL Z —V.! Rr P; ',If of' "ervlce vtr�'! Ci
<br /> P1,JVP SNSTALLATII`11`! MoniterIna Well
<br /> DISTANCE 70 fgEARFST. SEPTIC TANK SEWER tINES Dispc"-i%L PLEJ PROP LINE.—3C�g
<br /> FOUNDATION Sir AGPICULTIJAE V-1-1-t VELL—--- PfTS,SLj%IPS
<br /> jNTEt�DZ[)USE TYPE OF WE L L PqO0LfM APFA ColiST�9k,--T!0!4 �5P�C:FtCATi?ONS
<br /> Inoustw,ai L,`Oper,Bortom Manteca D-A cl Wel ELC,11AI1OfN D.z, of Well Casing
<br /> tt!-Lo,esi-c Prate -I G-,vei PaCk T,f"y of f."05.".4
<br /> Publicth.r 00;.l Depth of C,100 5n41 Type of Grout--i!26 i!2611
<br /> "Or?'
<br /> pp'O'I Depth - i Easlwri S.gf—d S--Inclelser hr
<br /> 1 J. H P State W*'k Dn'e
<br /> Fil Wo'k 00"e Typo of Pump -,b J
<br /> '.Yell
<br /> Dristmcnor. Well Diameter Sealing ;fateriiii.l L —PtIr.
<br /> Depth Filler Mterii! A P-Pth
<br /> TvPk OF SEPTIC WORK. NLW INSTALLATION HEPAIR�ADDIT!014 E-ESTVII.ICTION i i•—SeC.i.c %,Sid,pelrviotcrd if Pl'b:,C Sqwaf-5
<br /> 200 feel.1
<br /> Installation Residence— Comr,erCia! Otheir
<br /> Numtibr of fi-rig units:— NLMhe:of
<br /> Character of sod 10 4 depth of 3 feet: V4 alb, sable depth
<br /> SEPTIC TANK 0 ' lypiti/lipg No.Cornparlr n!q
<br /> PKU. TREATMENT PLT,C-1 Method of 06sposal
<br /> Distance to nearest: Well Founddi,on ---Property Line
<br /> LEACHINr,LINE 0 Nr.A Length of!-nes TofaP!crglh!tza--
<br /> FILTER BED Distance to riesidisi. Well FOUnddllln Property Line
<br /> SEEPAGE PITS It Dop;lr __Sue
<br /> m
<br /> SUMPS LI D;stj.,a to nearest: Weir frouriclat.on Proper., Line
<br /> DISPOSAL'PONDS -Cl
<br /> :0 hereby Cefl,ty that i here p,epamd this applie I ation and that :ho wori, will be dono in arcmcjdnce w-tm San Juaqwn County ordinances.stale Idws,and
<br /> rules and regulations of tho San Jciaqu- Coiinty
<br /> Home owmar 64 bconsed agent's Signature certifies the following "I rell,ty Th4'in the Lrc,'a—jnc#i of rho work.!u;which INS is issued,I shell not
<br /> employ any'qersor:in such manner as to Become subject ID WL)rIkm5n*S LOMPenWITirl,IA+WS 61 ca;.fofn,a-`Cnin.rravor 5 hiring or sub-contracting signature
<br /> certifies the Iollm"no:-1 certify that in the pmr(oimanca of itis wo,lcr which this pwmiE'S"'Sue",I Shall employ P"'O"subject in workman's compens3.
<br /> h hon laws Of C8100frkla
<br /> The applics m}t caa for all requ-red inspections. Comolitio d,.-,-g M reverse S-de.
<br /> -7
<br /> Signed X -7-
<br /> ,L ------- Date:, 3
<br /> FOR DEPARTMENr"uSE ONLY
<br /> Fil Application Accepted byPalo Area:49W
<br /> I/ A, I lop
<br /> Dale 11"nel IrIsp"cl.on by
<br /> Pit Or a inilipection bv
<br /> AdditionComments:
<br /> :tY
<br /> Z.
<br /> Art,ll—t - lin torn ,I I to: Nnn J�qjl 1 n ('n�.,ty ll—Ith
<br /> I R
<br /> an Jj,;,-4,,In 1, t I
<br /> NFO AMOUN Otit, AMOUNT qlEk'I'MED I T�7 RE CE-, C'By T-?ATE PERMiy NO,
<br /> :3
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