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API11,1UATIIM �/ -- `
<br /> 3r1N .It1AQU1iI COUNTY PUIi1,1/.' 111:Al.'l'il
<br /> 1:NV 11tt1NAI1:N7'AI, IIEAI:l•II 111 V 1:;10N i I
<br /> I4t1 N :SAN JOAQUIN, 1'110N1; (.20:))•if;1}-J'1''t)k
<br /> P o 1111A :1.0119, :A'(X'xT0N. (:A 95.161
<br /> PF"ItM 1'1 _YEAj4 _!•.1tt)M_I)�1 q.: e"'Suril!t
<br /> �, ,ii!:;rlr•rr• !II'':II , --
<br /> .tI 1•r. ,•
<br /> t_
<br /> APpllcwtIon le hereby awtde t-: i!i. ...r per_. .,•.•r„l • e,,.1 r 'i;atr.II e.l.r v•rIt t. r I , ,rIh.•,1. Tt.fa S
<br /> a1.41!r-AL1 Un la Gane In
<br /> rcaG•;I— a v1U •tat, ,.n.I.�I,i •yr,•v , ....nr., N. i er, ,• an,- ,hi- v�,Ins snit Ye•,(,.lwr t.,n■ or !:wn
<br /> JoaQuln Count, Flobile Healtn !;e r vl:•ea. _ !
<br /> / r
<br /> Job A:1d,ess ► (• /1�3 ^YL-�k1f� , ..I r•- �- r�l Ze-li IL`•--c vu —.
<br /> IX
<br /> OwouY Namef �f/� •t.e:< /�f��J/.� f7 C� �.(_
<br /> l /U S. J 4t.7Lf G4t,..(.Z .• r. )J / t•r,unr 9V_�
<br /> ) 1�
<br /> TYPE C)f WELL PUMP I Nt.,WfI1. .'.,t: t •�• t'.I;r�. i f;,T•1,1i_rION .,•.t of Serv!ce Yell ll
<br /> PF;MPINSTAItArION ORIER i. MoiIt,,rIng Gell f7
<br /> DISTANCE TG NEAREST. SEPTIC TANK _... . SEV.EP It1sF; DISf'U]AL FLO- PROP UNE
<br /> ------ FOUNVAt!014 AGRICtII TUNE t:f, .- 0Teti A WELL ._ PIIS/SUMPS
<br /> INTEA_O:D USE TYPE OF Wt I PR09,FAI ARfA CONST C.TIUN Si+ECIFICATIONS _- ------------ -
<br /> i!Industrial I.i Open Fioltorn M♦rite,+ U.a 1 W.I.luceva�mn ---_. - - ' D.6 f We
<br /> (I OorrltucrPnvale Gravel veck Tre.v ./e I Ca." H r
<br /> I Puhhc . 'Other , 00114 Dept :.I;,ou, Seal i�t�`�•
<br /> a+
<br /> Ir,yJ+tion 4nlwoa Dwplh '� I Ert!wrn Surf Ce Seo,Inatal4J by.—_.�..__
<br /> 94
<br /> R^pea W:xk Dnnc Trp*of P,.,no ------- R P -- --- -- --. - --- Stale Wort Dene vIF
<br /> r.-
<br /> 1Yr;l Destruction .. Well D.amelar —__ 1'aal!ng Y�urtal i Ileptb __- 1Ar,,,tN QV k� F?
<br /> Depth Filler Katerlal t reptn— �farf7t TY11•{$�RVI'�i`I�T� �,
<br /> TYPE OF 5EPT,C WORK NVAI NSTAI.LAf101. HEPAIN-AOOITI.iN Dt"i Rl1CTION INoe�AqT(f.1t tremfled d public&-J-*. Ie
<br /> avabrf6M•wuMn n,Net;
<br /> Inusuation wru servo Residence__ Com:rnaruN _ l.�lrer
<br /> Number of!-in un,ts, _ Numbot of badroums L -- --—----_- �,
<br /> Chaeec Nr G'kN to s Depth of J Iwt: %/ater Isola depth
<br /> SEPTIC TANK U Type.,Mfg _ += y_�•✓vCapa:dy_I� v- No. Compartments _
<br /> PfcG TREATMENT PLT.U �'11MelDod of DlsgDistanceWell ,�5
<br /> Distance to nosiest. We .lr✓'_ uunderion /V Properly Line ZLr 11
<br /> //��•''77 T' �J
<br /> LEACIeNC UNE 0 No.8 Length of 1-es ,�.Y// n_- Tn I n�tnrs,ls
<br /> FILTER BED (:I iJKtanq iC nelra2l: Well1��[7.- Founcahon y�� 1PropenY line
<br /> SEEPAGE PITS 1 I lloptr _ ,j_ Site -
<br /> _ N °
<br /> nt r � I `,
<br /> SUMPS Ll D,alan.e to nse,esr-. Well-1 (LFo.:nden0n JiJ � Progeny
<br /> DISPO;AL PONDS J
<br /> I heceove p
<br /> y cen.fy that I he" this a$;plwation and thee the work wet be dn
<br /> (Ione in+cco•dact with San Joaquin county ordinances. stale laws,and
<br /> ruts and ragulalWo of the San Joagwn C9uvty
<br /> (some o-ne,o•licensed toenFs ugnaturs cwn,hes the foeowe,g "I candy that in rhe{,o,}onnrnce of the week to,wn,ch tris permit is,cued. I chail not
<br /> employ any rmoon,r,such manner as to become s:.Clecl to w kman•s comoensehon laved of Cahlotma Convactw's hiring 01 sub contracting signature
<br /> unrbes the Ict!owing:-I cerh!y t',al in I"pericrma,xs of the wo,.for which Ilya porm•t a ithmd.1 shall omproy peitons subject:o workman s ccrnpensa
<br /> hon laws of CAl torula..• -
<br /> Tne applicant,. r�71�/rLOtt for et =.A$ ns Corr,prote dra.•nnq n:,reverse$,doSigns-X—_ „ FK2✓ --- E,ha - .l.}-'�-.�_+_7r.d._- --- - Date: t---t---�
<br /> FOR UEPARTMENT USE ONLY
<br /> by
<br /> Application Acceptedy �--`--+•.•_�— --- -�!-T 1 7- c��� —
<br /> -
<br /> — �- /
<br /> Pit or Grout Inepectron by -- -- - Wh, _,---___ f,nw,nspechon by d1 e�'1-<-(�_ Date
<br /> Additional Comments
<br /> App 11•ant - Het irn al l r..io, lo- tan .1—julh ,nunly 1'nLl 1, Ilnrllh :;e r'.1.',•.
<br /> knvt n,nn.•ntrl If r•alth Pornit/3u rvlr,•n
<br /> 11 �� 41h N hart .I,.:,1�,illi 1• ti 1;a '.!i,il!, Yl kn, ,A ' •.n1
<br /> FEE AMOUNT VVE `AMOUNT Rf MrfltO C��T of CEivtO ev OA rE PERMrTNF 0
<br /> 24 19(v
<br /> NO
<br />
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