Laserfiche WebLink
APPLICATION <br /> SAN JOAQUIN COUNTY PUBLIC HMLTRC1tR tt 5 C <br /> ENVIRONMENTAL HEALTH DIVISIOr.yj - -- <br /> 445 N SAN JOAQUIN, PHONE. (209)4 8E�,3¢2R <br /> P O BOR 2009, STOCKTON, CA 9 gel+$ —,—T---- <br /> ZA IT ERPIRES "EAR(Complete in in 'f Piplicate) <br /> A' Applicatlon 1a hereby sale to Seo Joaquin County for a Pevs}t to construct and/or Install the work herein described. na. <br /> arplicteion So Road. to corpllanca vith San Jwyuln County Ordinance No. 549 and 1862 and the Rules rued ReRulationa of San <br /> 1:. Jo.9uin County�PPub'llic Health SerYlite. <br /> Jtb Add.... �_f-..L_.1.�- �1A�-L � — C'ry Ff �l'Ot Sita/AcreaSe 96 <br /> �e:�� <br /> Owwf�NemO_J . f V `T I L� AddrrrtS PMne <br /> Addicts. Gni CO Locenfe No'1*6r -N1.x me <br /> Ll <br /> TYPE OF WELL/PUMP: NEW WfLL ❑ WEI.I. REP'.ACEMi't" 71 DESTRUCTION ❑Out of Service Well <br /> j, <br /> PUMP IWSTALLATION G SYSTEM REPAIR L'1 OTHER ❑ konit'rin; well C]N <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _ ., DISPOSAL FLD._ PROP_UNE — <br /> S, FOUNDATION _ AGRICULTURE WELL ___ OTIIER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS p, <br /> ❑Industrial ❑Own Bonen ❑Msmaca Out.of Well E.uvat e- D4.of WON Cupp <br /> r'1 Domestic/Prlvste ❑Gravel Pack ❑Tracy Trott of Cwin9__,_. Swciflcallons W <br /> Il Pnblk I:1 Other Il Doiu Oww"el GIN" See _ PAYMIEN-F `U <br /> I I wilplan, __Ameo.. Depth I I Eastem Euchre Seal Intlel.d W f <br /> Repair Wart Co., ❑ Type of Pump _ H.P.----.._-- State Work Owe <br /> Sealing Naterlal A Depth -- <br /> IIIY 7 IJYI <br /> Wel Destruction ❑ Well D4metar Piller Material L -Depth -- OUNTY <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION' DESTRUCTION I I vO wpo(, HAD I S <br /> / asits"" %•IHEMH DIVIal <br /> Iuutle,w YEN'""- Rotibence 1--� Commercial— Olhw <br /> NU6.tw of living unita:1— Number of bodreoma <br /> Chs•Ktw of WN to a depth of 7 lost: A-�V /1,4NJ .Water tele depth <br /> 13Tyya/Uig _ _� CepatAy No.Compdrmrnn <br /> SEPTIC TANK �( <br /> ' I Method of Olsooeal (� <br /> PKO.TRe.ATMF14T PLT.❑ <br /> ' - Distance to ftwwl: Wall Foundation ._ Prgwny Line_ <br /> lfACrING LINE No.1.Gareth of lifts_ °�� Total lefpth/tits <br /> FILTER BED ❑ Dista 0 to ft,,es, : Well u/-�R F.vnaatwn?/1 FT Property Lina <br /> 'SEEPAGE PITSNum�rber <br /> ° £ r <br /> SUMPS 4istanca to naltmt:' Wall A�qr FouhCwne inn,St"L PropaLine <br /> DISPOSAL PONOS ❑ <br /> I ho,,my O,mfy that 1 h:Iv1 WNMrW this application and the the wad will be done in accordance with Sen Jwguln Cooley wdmar..n.stag ben,era' <br /> ruler:and fe"tb,u of the San JwRuln Cor ty <br /> Hama Dana,or Ikaneed agent's Still O Mif4s the IoP.owIng:"1 sanity the In the N jjwmance of+he won for which this genre Is 40,011.1 ahaM wI <br /> whooY MY Waon In such r ,Ni 1a to beton subject to workmen t cnmDanwtinn:awt of CeiINh..'Contractof's hiring Or eYOCMIrKlhtg llghature <br /> wrtdEn the ICNowing: 'I carRlY the in 06 WO'MSnce of the wcrk for which this thi IS iwued.I sNN employ persona subject to vn,kman's ca nae <br /> tion Is.o/CWfurn4.- <br /> The applkrrH nunit caa Iia W r Ina/pts' n. Comntau Brewing w reverse <br /> slgn.d r <br /> �/ .��fci, — Tllir o'�7A''_%.^rL _ Dau: <br /> FOR DEPARTMENT USE ONLY <br /> / y <br /> l,-rylketbn Accepted hY ..— R� I Date - m--C---��9f <br /> 'PIs w Grwutlnspection by. Dote FMal lnspecbon Ops <br /> Additional Cer tai: <br /> ' Applicant - Return all coPles to: San Joaquin County Public I(,.mlth health services <br /> 4uvl roewnn Ul th PeNOR t/See <br /> rvale <br /> 445 N Stn :o heal P O Boz 2009, little, CA BSNGI <br /> 1 EEE AMOUNT DUE �AMO�UNjT(RRE�MITTED C r,n RECEIVED Nv OAT! 1PERWT N0. <br /> I <br /> , <br /> W ......... . .........�...�. <br /> amu NeYbAlgdChSt.'SPYKiRVMO.1�"t�A '..ane ^" <br /> Tl, 4 <br /> 3 <br /> I` <br /> rnr._ <br />