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t APPLICATIQI'{j FOR PIMIT <br /> 4 SAN JOAQUIN COUR-Ky PUBLIC WALTH SSHVICSS <br /> . J rviRoMMENTAL H$ALTH DIVISION <br /> ' 445 N SAH JOAQUIN, PRONE (209)46$-3420 <br /> �* CA 95201 S C P 1 8 1032 s <br /> P o BOX zoo9, s�cToa, <br /> 1 iAN JOAOUIN COUNTY ' <br /> � IT EXPIRES 1 YEA&,VXQ DA IS= <br /> °1'f LfEA TI''SEf2VECF»� 5 <br /> (Complete in TriPliCllte) rr+.shsll\�(�°l�n1 `fErliidiplVf$fOfV <br /> l AyPlicaeiots is lerelgr oade t0 flan Joaquin County FaY n yesale to aoaetruct and/or install tate !lark be:elA dee�cribed• This 5' <br /> - alma of beA <br /> agPl;catitla 1a osde !tl Caipliaaee with Plan Joaquin County Ordinance No. 519 are 16611 sad ttM Rales sad Aa{ula # � <br /> Joaquin County P01Je ill Ser"cee. z r <br /> CIIYIot Blte/Aevease . } <br /> Jt�Adt <br /> , 4 1M+ena <br /> M1 k�4 Add, <br /> Owner a Nmne ` <br /> k <br /> AddLkenae No <br /> " Centraetr ress - <br /> r a �� A <br /> YPE Of WELLlPUMP N WELL D WELL REPLACEMENT fl -DE9TRUt:7tON W4 e � r s I <br /> PUMP INSTALLATION SYSTEM PIEPAIII r DTNEII Q ^owitm1 } 1 .f = <br /> 013TANC4 T8 NEAREST SEPTIC TANK SEW <br /> LINES DISPOSAL FLO MOP UNE <br /> FOUNDATION *ITi31SUMPlE <br /> AOAECULTUAE WELL OTNEA WELL..�� <br /> - INTENDEDY y - _ <br /> �Q USE T'PQ OF NIELL P1lOIfLEM AA!A C4N5Tt1i1CTfQN SPECIFItATICN8 <br /> Open BsroaM 0(Manteca INS of wee lxcavelfon DW of WaM CAtl�E <br /> - " Inaussntl eev TvW of CMW4 x V <br /> +tt(DameplaINW-to Cf Orwel Pace TD a Depth of Gtaut feel — upti of <br /> ll Pubk n Other <br /> Apth 1 1 Rester"Rester" Surface Seal 1m1eIMd 011 <br /> ppro■ De - - <br /> State wort <br /> �t RapsM wore nous E3 Type of fhartp "P <br /> I „ (kealLos Wri <br /> W40al i Depth <br /> Destruction 0 WaR Dtr"ter Tiller eaurial R DeDt>t. 't �` ^'� ;' <br /> LL ted M ptteac Maar i•r« <br /> 7YPE,Of SEPTIC WORIt NEMC INSTALLATSON 1 I REPAIRIAOOITION I I DESTRUCTION I i INo No-septic ayeteln P«rrw <br /> ara"A wdhNs 700 last 1 ,� <br /> - r✓ `_' "_, r' i _� Corr■tlerCiN_. Other <br /> tnatagatlorrwiE carve <br /> Nlattber of Meng unO Numbor of bedrnortte wal« <br /> Chras%t of feR to a dei."+of 1 flet Na t.O1t10af""Oft <br /> SEPTIC TAUK C Typ IWe CapaettY -4 .1MdedatDispeeal '�,Y T i„�'rfaz"".�� <br /> PKG ATMOIT`PLT <br /> TTIE <br /> roeereltt� <br /> Woo_Fotrndedo+r PrapaAY <br /> To"a UnpMltdee <br /> -`LFACH NO LINE Cl Ho Z�Lcn9th 3f 1'xa Fauntlation_ - P+apm v <br /> KILT"DED Q Disumw to r-03100 *4a*4aLL+a <br /> sw n r 5 <br /> r se S Sire <br /> SUMPS PtT$ Lt Dlatartao - Wail Foundation ProWnY <br /> v '� <br /> SUMPS to nearsal <br /> DISPOSAL PONDS O <br /> and that the work WO be done in acmdwwm with San Joepain toOlrrtlY orditreltLee•ttLle IMrer 1.0, <br /> a - 11Mreby aelufY t1N1 1 htl■e Aeeparsd this appBeation r _- <br /> F a�=� - c fine of the Sen Joaquin cum!, 4,_ „ r •�'�' �r�y . <br /> �� • ^ rules irtd reffl+� of the wtxt fa ethkh Idtie P+�'N sac d:i Wn set:;wj <br /> Noor ewrw a irenced agrrtt a signature cerun”the F"owry 'I crtMY tltei N tM perforrnerrt a a <br /> a altfscontr111 tYtp sialatut+ <br /> tbn Iarrs of CaRfomis"Comrar tars hiring 1p wtttllttlBn s oert10stMM 1~ <br /> snwlpY r+y in etrelt Irtrmert�ln pia t»rf ntanca of to <br /> wor4efaewtt�Ict perKlit is lewd 100«.0oy?wam eft to Wooki R; ry�,; Y ;, <br /> oer0Saa the estrNl� <br /> .^rYs= ^5�t �- <br /> 4C° A.rr ter'' iM-r do IMM � - � - - to an _ ^ 1'--.. - _-^ �. � ` b/�� ,�»"' a <br /> I-z7 5n A r The Go for aR µtamvle dreMkw Bide • s.t �X `,t1'�JtL� �F��.� <br /> TitMPARM USE ONLY <br /> bV Data ata <br /> Aopk4rdn Accepted <br /> M. <br /> $ <br /> F <br /> row <br /> Fi++al Irl.prctiw� <br /> Ph or emit inert-by Date - <br /> ' AddkMnd Carr■rrrae- T d-applicant - Before all bogies to Baa JowMin County Public tlealth Services <br /> Boviroareotal Health Permit/Bervlces �> <br /> lM1: y �.,�.y,ire♦ .Y4 <br /> 'Z4 <br /> .. . 44a R 3aa Joaquin. P O Box 2009, 9Lxd> OA gBJ01� -k <br /> F <br /> , - r BECEtYtjD fIV - '" pA „"' fERaAiT 1iR �.s`s '"y`}ylre r,�•� •K- <br /> r W - ME AMOUW OUR AMOUNT IIEMM60 <br /> �' � ,T � .W1}fe laeV gra■s <br />�i•��r , � tM IbL � M ` r_ <br /> INFO <br /> {•:a� �` • S Sx r3„'9 "iii+,ai, tQ�.x"u3e`:.t.�.+,tk ti.sn..J'a 7 <br /> v <br /> 4im.'`'+'�-s <br /> 1= <br /> > , <br /> 41a',��y,ys.pf• <br /> ;ti <br />