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APPLICATION FOR PER;
<br /> SAN .:OAQUIN COUNTY PUBLIC 11EA.L771 SERVICES
<br /> FNV 1 HCWidFJyTAI.. liEALTH DIVISION
<br /> 1601 L. NA4ELTON AVE. , PHONE (209)4f3B-3420:
<br /> P U BOX 2009, 3Tf'CS7TsN, C.1 952U1,
<br /> zzaxl�L ' SAA FRQM DA
<br /> Ca-jssuxn
<br /> (C0trP1vte in Triplicate)
<br /> ApplfcatF.-n is !rr•'ry esd, to ren .:c.¢q:::: t'c,rn•,y !nr n Fr'a='- <nnetrret •:,tTJo.• 'cc uall the vrrk Ix rsi r. ueaerleM. TT;
<br /> ■yplfcatlon 1. made In [artpIl►r,ce u:ih 9„'; J!.arluin Crdl.'Ance fro. ,49 .cd iRb2 snd the Ra es rnl le�latl,ne ar Sr*
<br /> :oarluln County F'u41;c ffeklth
<br /> Job Aed•aaa .t11��•1 I. '"t 1_VtL�I',.SLh-r`� - -----. i'.rvC'TLC�_ i.ot glrel Ac rewltr L� �
<br /> (�,, ( \ `•l
<br /> Dwnar't Namr - .Jr_ 'V� 'R
<br /> S!
<br /> f��J;,,.`�yS�'``77 �J .,`}����ee�� 44 rte, 1
<br /> C bee,atlaC: t,ts��lC��c;j( h��'�',S lJ V��7r L_ ��_.._ 'a. •r, -,]cl27 6 pay-e
<br /> TYPE OF VdELL'PUMP fI fv F.Y v.EIL .,ELL PEF'LALEI.It'rl C=S'.tucrION J Ort cr 5err:c4 veil LJ
<br /> PUMP INSTALLATI,fI SYSTE'.' °(calq OTHER , Mani Wring Ve::
<br /> T.
<br /> 01STANCE TO NEARES' SEPTIC TANK SEv1E F' ; NES 015'05At F'0 PPCA LINE
<br /> FOUNDAT;ON _ AGn1C"'L%AF .'k 07rpR WELT ?'TSiSUF.1PS
<br /> INT(NZ)ED USE TYPE OF WIL f uOf31 F!.!ADI r,
<br /> }ndustrar C1 Ovtn Ba ItYn IN.nre l.e ._ 7 ol.v.eo F .,,.rr T_ ria of Won Gena '
<br /> Do.rralKIPrbalt :.7 Gra. pack T,.,r r.ne or rrnq - - ------- -. 5pe.-F,cat.ons .� .
<br /> Trpr of Grn.,t
<br /> Irrrpalron A[?Tao, Dnp'h 6.r.em 5"facr 5r,1
<br /> Rrpa.f Work Dont I i Trp.•of Pump Ff N .---_-. 4fne Gho,l Don.
<br /> WON Drslrl.etron iJ Waa D'arr.crr+ _.-_- :reailr.It Material A Drpth
<br /> Irtiler Fvtfrlal i >pt5
<br /> TYPE Of SEP TIL WORA. Nf'ei I4S1 Al to 1101; Qt PA0C)?T 101 Ot 41 nUC 7ION I eNo seot.e srsfam predn 7"NIC W.Yrt w 1
<br /> -a. rm.nble-ihrn 290 rrrr.I
<br /> . _ s
<br /> NunKrar o1 YrnQ un,ia. t[ur•1x•otY.'e0cwr:s --_
<br /> Chvaclw of goo to a depth cf.1 fr..t.
<br /> Water faoM FIaPIR ,..-
<br /> SEPTIC TANK C7 TK'&!M19 -------------------- Ca,unf -.-- f+o.CorrloarvP*Mts
<br /> PKG. TREATMENT PLT.F:7 ;M*no'1 of Dapo"
<br /> Drstance In n &-st '.Vrf! Fp�,,rrte!rn Pio r1t LMa
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<br /> i
<br /> LEACHING LIVE l` No b lenylh Of Irma _. _ _-___ _ _-.--_._. __ TOIa;Ien6;n.s,rr
<br /> FILTER 9ER IJ O'Slance to,w,esl V1.}i Fov^C.lrpr. _ Prco-rry Lrne ¢
<br /> t r j1
<br /> s SifPAGEP1T5 (),ants j. .�. r• _�1 ..-- ----^�•n•txr =�.., 2
<br /> SOMPS t : ulblance to naarast vv.n r t' Fo naal•onLwWr.r
<br /> DISPOSAL PONDS 11 -
<br /> I hnebY!en!fr IMt F MH praparal rt,n epp1K.1 K,r.rr,d'.n.+ rr,a G.e..r,a,e..crd.n.-e w,n 5-Josuwn count'ord'narrdes.Pale taws, and
<br /> Iuira SM 1096-lalrona Of I"San.10414"rn Caen tY {
<br /> Horne 0w wf Or I.,anaad apaF.l'a cervi-.a acv!C,6[,H np I cs i'r rh4f,n Inr M^,-Ance':r the~k Fpr w�rclt thN pefrnrt ie d*wd,I sh&MI
<br /> ernplor any r raon x s.xh rnannw[as to be[or a,.nl!.C't rb_,r<%,s ca;�,915ta;-0n 4,'.1 C,forn.a C'nnlrw.rpla M[a+q M sub-conlracrAV PQrwtVra q'
<br /> csnAms the follpw"p:"I camly that rn the Wno.manca of Ina„n,. •v,rtn,(n tn,s pe'n't,a,se.ao s.Y'l 0-00y Pe'a0na I&VbAc1 IO rrpekl Mn'a!Ompoftsa
<br /> t-on lawn of CalAwnis," "ill
<br /> The sppl!canf-qws! call"W,e!WQurrd,nsprct.,'.a Crr,t.+r1a d,aw.nj
<br /> Tne ] �A ' - Darr. - D
<br /> JFOR D[F.,RrMkN', USE ONLY S
<br /> APp1.calMn Accrpteq by ���-.-�-��4--`../C.iS'._iz-���_.-. :.I•�__/S:-� Arra
<br /> rIt Aw Grout InsNe:trow by+�-- � a"L'_ :)ata 7 .j,�1 i__ final;nspe!Gon br Lam. E1afe//f�_
<br /> Addltlonal COmrranlf. _.___._...._-'-- .•
<br /> App)tcant - Raturn s11 CC.pfa■ to: 1'an J:wgalc Cp ty N'.l:c 11e"'L
<br /> Serrlces, Yr.rlrormen'.r.l isealth Per1Ut!54-r11ce6
<br /> Ifr01 C. }Late:irn Ave., P 0 blaa---r2-0-09-, 9tcekr.an, CA 95201 :tr
<br /> FtE AMOJNT [)erL �A MOVr*T PIW"Fd C K aaf ; FIECf1VO 1!r DATE 1E RFJR MO. rT,
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