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AM'LIOATIUN FOR PERMIT
<br /> SAN .JnAQWN LOCAL HEALTH DI STHICT x;
<br /> s'—C9
<br /> H�rQ'_TOtJ AVE., STOCK TGN, i t,
<br /> T-forhont! 1209: 466-6781
<br /> _
<br /> PE _ FROM Q
<br /> Fii,r11T EXPIRES 7 YEAR ROP.�I DATE ISSfJEf7
<br /> ?.�`Fyrr ---------_----
<br /> (Complete inTrip!ir..a 1:u) ._..._.._. .�
<br /> '.`��� 1.rypl•,:ii,.nr;i5 tree fall mad1v to th,San Joaq,]n LOC+f!}f,ldlrn C"51nr:t'Orn n"rn1i; to r. n,lr Lct an,l:::r urS;,l11 !hR r'. fir:.herr-in[CSGrI,L'd, hes np::rC.lSi+r.1 is
<br /> ���YYY r.•i.'../i;c enny,a:m:.c San an Jr;ar}ui:e COLIrtti OuW,i:ICd iJ�r.!-19 lo,se:+:r,l L•or flo. 1RGl fIn
<br /> or vrc^.'yurrep;mo c l's'es hu
<br /> ' and tai rola buns of lSan Jodqurr
<br /> •r r-
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<br /> XV J"D Add,n55 _ �Ll._ _;'_V_� J_�f.J __._,_?S-4�___— '"'ti "'4- -f�' __---------- PM
<br /> � � $• F: Ownw's Jame
<br /> f--_ � r
<br /> Contractor J _G 1_! J_V'.,"7 FS I_ss
<br /> TYPE OF WELL-1PUMP: NEt,11 WELL !:] 'vVE'!_f'sL PLAGE3.7Eiv'T i L:E 7T11tJf:T!ON i's
<br /> PtJftiP!NS'ALLAT:pN ( r SYS E A REPAIR ! OTHER ["i
<br /> DISTANCE TO NEAREST: SEP TANIti 5E'.:'FR +.ifJ ' �.�-___--- (]!�'C)SA F'LI]. PROP. I ILIL
<br /> 4 --' ---- -
<br /> y a -, -- FflL'NUA7!CN=-- GRILIJI.TUHE WILL )ItIEH WELL-__—Pii:13UtJSP—>--- 1
<br /> ?t ------
<br /> INT-.%OF[)USE TYPE E OF WELL f HOF LF. AREA CO,NISTR[{T ' SP {IFICATIOWS _ �V
<br /> .:anter-a Gia, of W,IJ f•c.,t ticn_ --- -----_- Dia. u!Wrlt Casio(?
<br /> r. t
<br /> [] DoesticlPrivale :,ravel P'ck ! i .rn,.+,, f pe of Casu.tJ-.
<br /> n;
<br /> ii" moi'+ I'= Public �1 Other De:r, Dnptl;of Gro--t Seal ._—.___.... ---_-- Type 01t ('Irout_____ --
<br /> ! I ItrLtatinr, Au;no". Qrplh _:uri,Jr.d 5L•,0 I',st311a;ti by
<br /> 's Repair Work Done '.-_I Type of Pump ----'--._..._ » `•' . ------------- Suite Wo:k Done -----__-_--
<br /> �^ r-
<br /> Well Dentnt,•lion [_I �— f I -
<br /> t� M1 i'i Depth __ h+.: . t;a>.e:r'dl If3.afeN C�'J .------
<br /> TYPE
<br /> ---TYPE OF SEll T!C INC)RK: NEW 1NS11+L'I"l IO ?t p;, AAD!11;)..N I 1 (AS t RUCTW)NI I ! INI: N:,nuucd i! public ;ewer is
<br /> :�y acaila hem wit},in n1i1 te,>t ! '.
<br /> t'rS
<br /> , " ins.allacion wiil serve-: Residr'ncr. Cornmetrrul
<br /> .1
<br /> Number of living units: �_. NUmbcr of bedronn,s
<br /> Character of cafe so a depth of 3 .ret:
<br /> .:.,, t':arer tab,c de>t`r
<br /> SEPTIC TANK I_) :I R u, Comf artr.n:n.s .._
<br /> rfi z1^ PKG. TREA1
<br /> -ME' PLT.1.3 Method of Di>posat
<br /> Distance to nearest: ?roporly Line L
<br /> ZQ
<br /> sa LLACHING LINEJo. & Length of liens �,-,____ _(/s✓ __— ___._ Total
<br /> f3ED - �' i.' D}stancc m nearest, VJcli �fi 1 ot,ndminn Prot)erty Llnrl
<br /> r
<br /> 5ECF?:IOF PITS �; Dr!;,m _C•�-✓,—.---__ Si:F; Numh3. . 1�
<br /> w y
<br /> T•y�> f`trt:nda nor+---/-a�,J. Pr=.rper;y Lm,ll
<br /> l 1 Design Cv :[�I,e',d1Eot: VJra! f,/G/_.- f ___J_._
<br /> DISPpSA.I- PONDS I.;_--'
<br /> ? '-Ss Z I'reruUy rflrtify that I have prep.,sred this spphicalion and that the wUr L.w:II I)c rinnl:it,docr;rd,-,nce wish Sin Joar,,lin county ordinances, state Invrs, and 114, '
<br /> f � rules and regulations at the Slip Jnatj,:rrLor.9! }loallh Uattir I.
<br /> Home owner or lieen:•ud aflent's sift:'.ahur t.Crtibos tho followiriy: "{ramly that ire the parformar n o!tJ}5"otk for which th-s petn,il i issued, I shall not
<br /> k^ ortmpioy any person in such maonar a!:t,.}oncome snh;eCl SO workrnnn's cornpon,a!u:n latus of California.'"CJnim-,tor s hieing cr sut-Connacling s:gnat±ere
<br /> fef[11fB5':FtO following:"I coni!•/:.`rat in the Ix,rforrrW n,;e of tho work fnr which thrs pr;:reit is issued, I shall emp1 o� petsons sut);wt to Workman-s cornprinsa
<br /> tion Jaws of Cali hmla."
<br /> . Tho Hp,:IfCaal ilraw.'inp Olr reiv�rstr:icl,,,/1 ------
<br /> Sipned X.-----...._. ---''--`-. - .--_ - _�d:-__ ._-G'_`_"��r_'4:'_t»,:1�L=� flare' ---- --7—
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<br /> ( r\•TOR DEPARTMENT USL NLY
<br /> Application At:Cnptnd by '�:_'� �r^_ +)'t__LJ.�1���t.�'.�.e,,n)�'t�^��---- Data�-'--�f������ _. Atua ----t--=----T.
<br /> (JP
<br /> nt Lr'Glom lnSpnCrian h' _rrte`- "�'_,_y_ [3.e1 :f.w-, -_Y.� deal Inspet6on by
<br /> ,; + AL'dlllUndl commonts: Z'
<br /> Dl Srit 466.8781 L I_cdr 369-362', 1, Ptenrtkca B23-71(M (7 Ti E356385 ,�::_' a� ••`� r.�, �
<br /> r Applicant- Raturn ul1 copies to; Environmental Hna!tif Porn:it/Sr?rvir.us 1f�: E. Har011pn Ava., P.O. ©ow 2009, S:k., CA 91u61
<br /> AMOl11YT DOE aut)t)raT nEr-1.177[C) , ?She 7ECE14'EP By t):,T[ PCf?Mr? NO
<br /> [rr 1124 My. 'I' I _'� UJ �-_-r r ,' I I", 7
<br /> Cts 14.7a
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