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1 <br /> S/u4 .JCDA4,t01H COM."TY PUALIC HEALTH SRR',ICR3 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N S! .:2N, PRONE (249)468_3420 <br /> P Q UX 009, STOCKTON, CA 95241 FILE <br /> c <br /> 4 � <br /> (Complete in Triplicate) <br /> Applteation Is horoby made td fto Jawia County for a Permit to eamttwet and.or install the ver! berein described. This <br /> an <br /> applteatlon to d• in.cemiJ44" <br /> In <br /> ,11th Be-.' Joaquin Cmnnty Ordinance Ito. 749 and ISU mW the Mules apo INe"14tlem at San <br /> Joaquin County Public Wealth rtiaq®. <br /> Job Addrssii CAV Lot Sia•/ACrgye 1 <br /> Ow1w'sNar+r :fa, a �"�Ldelsca .., �P .. Phone <br /> 1 � . <br /> CIM+frlcta AtldrsAs Litent he,a41Nj–Pnar <br /> TYPE OF WELUPUMP: NEW WELL Ct WELL REPLACEMENT Fl OESTAvCT*4 tl out of sesvice Well Ll <br /> PUMP INSTALLATtONf 0 . SYSTEM REPAIR' � OTHER Q llaetwins wall C] <br /> DISTANCE TO NEAfIEST: SEPTIC TANK .^. SEWER UNES �_ DISPOSAL/LO. PROP.LINE <br /> FOUNDATION AGRICULTWIE WELL OTHER WELL PITSISVMPS <br /> 114TENDEO USE TYPE OF WELL MOSLEM AREA CONSTWJCTMN SPECMICATKWG <br /> CI Indusrral O OPan ottotrl fJ Manteca oft.of Mraa E.u.atian •_�__ Dia.d Mire ceeft <br /> } <br /> f I Omnssticiptirato Ll OyvW PacA 0 Tracy. Type oI Csainp_ Spat ralfety <br /> 1'1 Pubpc '11.01Iwt n Delta Depth a'Grout S" TapeM <br /> t I hripat:an �,APP".Depth I I an"" ' Surf Sart Mo*"by <br /> Repair worn Dons U Type of Pump SU N.P. 4 Sao%vt Davy"Keplaft <br /> Wee Destrncticn C) Wap Dia MW + tMfia!it►1•.Depti► <br /> Depth, Ila riper 31lttarial i Depth <br /> TYPE OF:SEPTIC WORK: NEW INSTALLATION I"I .REPAIRIADDIT*N 1 1 OESTRUCT I r e � d pmbk wow in .� <br /> IlNtsltetlen will saw: R"wom.._.... emm"m m_ OMgr� <br /> Nombsc of Erir,Q Ilrrin: Nuff6 t of beda'lla,ft�� + <br /> Chaacta of roti to a depth of 9 taps: .......1Ntalu�w 1trpM <br /> SEPTIC TANK O TypolMfq�,,,,,,,,�,,,,,,�,r,��,��,;,,Cb�iy � F1p,�wlpb,tllylyt <br /> PKG.TREATMENT PLT.CI i M Vme of ON0 d <br /> . Dltftsnbe to nnMaat: VVeli.._. 1Fotn10etkn <br /> LEACHING UNE I;l "No,b Length a7 rMsg teal 1rr+ygtflt <br /> f <br /> FILTER aED Q D*wm to mar= Weal Peundetion V►dpeM LMe t <br /> S!£PAGE PITS i! Oath`_. ._..Slrc .,�... N11wRbrr - s" <br /> SUMPS L! Ohlwm to nos"; Wap foulldNiM Ptglrtgi Late <br /> DISPOSAL PONOS 0k <br /> I h$"by sanity that I hm propsnd nft spaecatIon tate.tom the work wN be trona in scam t we vvkh Zw Jaagatn eowny.aadMwlera,MSM%wr,and <br /> Met.and redlAerlmw of the S:n Joaquin era ty . <br /> 14onM owner Or Newaad aosni'a slplaWM pe"njoe the JOSW Mnq:"I nanny tfrii"in the Ii.."rRae 0 the wank ICS m-00t Ulla VwM is tlpm L l MMS net <br /> such un <br /> ORVMY My oww In ch mods as to pw*m wbrm io vgmj hpn'a ownifI neatbn�of C&WQenla."Conveelela k*q or aaborRlric*%Wpm <br /> e Atha} M mooing:"I cor Wy that in Ute pr:Aurmgfw*of tide tmor4 fm wM;h IIS pamndl a iet1,l shall so*my OWN"tIttpw bwtwt+aan'a awnw.w i <br /> The sppiie t t coo few aG driPek4fq An IR+aIaD 6W& } <br /> Sion" Teta OM n <br /> FOR DIPAIMUEM 1182 ONLY 22 <br /> Appatstkm AetWod by �- F i// 1 <br /> _��.,.�+�.. Dasa' AIM -ai <br /> Ph er arcut Inapectlon by sista Irkwa Irtapee"t bE. —Mo <br /> AAdukfnN C�rtvnanq: <br /> f ' <br /> Applicant - Return nld aopBest to: sofa josquist causity Public Wealth f"Icee ri <br /> Arvlrew2eAtal Uoalfb Permit/Senio�ey! i <br /> 441 IO (Ida �Jo..'i min, P O Raw DOW. StNtt, CA "Sol s . <br /> f <br /> F1 AMOLWIr DUAh%XJNT KU41TUO OA A10Etm IV VA P *M'U0. ~:k <br /> I <br /> r � IF ' <br /> I <br /> 1 <br />