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• ik <br /> 1F �RIi6 <br /> 11. <br /> f ;:• .,�=G:. tw.r: _ .T� ]i1:-.� FERM'IT N0. i <br /> .Teje;,i:on" {2341 Lfio-Si3i OASC 1550E0� E <br /> pEov1T Er,PI?ES 1 YEAR fpOv, �':TE 355Lr�L• _ <br /> �i I ({il^�Pletp ir. Tr1pNCa:e) <br /> o with Sar. ;oa,usn County Ordinance No. 544 for sewage or no. 1862 for wellll7uaV <br /> fs hereby rude to the San Joaqu'.'iLaPtel Health District'•or a per, to construct 4nClor install etre wort herein <br /> described. <br /> described. Tnis epPlicarion is +^flee in co*o <br /> end tee Rules and °egulatfnns Of the 5a; joaQ D Local <br /> ubdiirision flare <br /> 21, e <br /> Job Address Address , <br /> Owner's Name C/ti Pitons <br /> �r�s L License No. p(} <br /> l C.ontractor'S Name —_ _ �W <br /> 1 a DESTRUCTIOp U <br /> 4Eu WELL G—A,44- <br /> WELL REPLACE7!E'iT j <br /> 4 TYPE 01' WELL PUKP irpRK: rJ G7nE't U 1 <br /> f PUMP INSTALLATION SYSSEsI REPA1!! U DISPOSAL FLO. �1 pRGP, LIRE <br /> r ' <br /> J-�--- SEWER L15ES � PITS/SUMS <br /> SEPTIC TANK OTHEPWILL <br /> ` <br /> DISTANCE 10NEAREST. <br /> Af-RI{L3_TURE ::.Lt ��� <br /> :4L'iE»i 1611 <br /> I^."i ST'ECiES{kTIO'b <br /> I TYiE 4f xELL pR013L�" CONSTRUC-. ' E <br /> 1p1fN0EO USE _floe ranteca Dia. o+well Excavation. <br /> Bottom tags <br /> Industrial U G Pia. o, Well easing s ; <br /> J ❑Gravel Pack SracY <br /> k Via:. U- pemesr.fc/prfvate pelta Type of Casing I' <br /> l - L3 public L�Other r- Eastern Specifications <br /> i <br /> Approx. 0 <br /> U Irrigation Depth Depth of Grout Seal <br /> Cathodic Protection <br /> Y. it Type of Grout . <br /> IJ <br /> Geophysical Surface Seal [nstailed by <br /> bother State stork DaneType ---.-�"�~ <br /> N.P. - ' _ 4 [�- <br /> 3 Repair Ucrk lone[J well of Pu" �� Seaiin,) NECriai "OP 50 <br /> s <br /> Well Destruction Well Diameter �� <br /> SS11er Ysteriai (delpw 501 <br /> 7'. Oepth public sewer is: ^ <br /> r ittni if pub o .r <br /> PEPAIxlApglTl{1i l:Cs septic tank or seepage pieva ante rithin 200 feet.) <br /> -`(YPE OF SEPTIC, x481:: NEW 1NSTALthtiO:i E1 <br /> �[ COenerclal ��rr <br /> 'T 4 <br /> S t `• gnstellatfan x111 serve,: Asidente F� 'LOt s;ie ��� + <br /> Nurnber Of hcdr �� Water table depth <br /> i Nunber of 1lving units: rtrents <br /> Cepat i ty No. CornDa s <br /> Character Of ::oit to a depth a`'a fee'•: , r'�� Method at Disposal <br /> SEPTIC TANK, IRJ TY9e11'fg Jp ---�`�' _f�pacity <br /> �� <br /> S c Mer .�--•--• Property Lina <br /> OKE,, TREATMENT PLT. ❑ YP ! 9 well ftundation <br /> Distance t0 ncares:: ---- f' <br /> SEWAGE SYSV ❑ _ �eTotal lengthlsire <br /> C.ESiP,VT107�!_ <br /> No, A length Of Ifnet' -i Property tine ! <br /> LEACi11NG LINE nantlen <br /> � f1LTER BED <br /> piSteRcc to ncarcit: xeli fou <br /> 1 <br /> �.�- Site--'"�'N`� ���- e. :__ <br /> i { 1J Depth <br /> SELPAGE PIS <br /> Fpundtttcn J Property Line <br /> * TNeil <br /> l f! ;ttMiPS l�l Distance t0 nearest: 4 s' <br /> ��. <br /> D,SPDSAL 54ti0S C I �� <br /> ! the eons w`11 be done in accordance with San_Joa9uin county" <br /> San icanuin Local (lealth District, of the work fad lifornie.' <br /> = 1.ereby Ceftin; that 3 have Prepared this apol <br /> tcetion and flat <br /> rules and rM)ulattat5 ai the Se rlmanS tearpensatian laws 0 II <br /> ordinances, state laws. andt,5 ti- andure certifies the foilowingt 'I certify 'JbJerthat fn the M Anemones of the work for whi[NI1II <br /> 40 . owner Or licensed ager rson in such manner as to becoere 5certi f tothat w <br /> n reifies the fell11wiIf,, '3 certify of <br /> California-'the a- <br /> ' permit is Issued. 3 seal-; not .ploy a Y rk_an's co•'t'ensation las Of [elifornia." k <br /> Contrtctor's hiring or subrall acttn4 s�gansusubject to wG � � E <br /> this ler It 15 issued. 1 5natl crpFoy pe n (rs-,piste dri-ing on reverse side. Gate: <br /> required 3nsPectio s. - <br /> ifi@ applicant gust ceT Sas+ � 'Title: r '�'��� ' <br /> 5fanrd x FOA.-- Si- SE-ON0 7_ 0 Stk 466-6781 <br /> t _ Area r-• <br /> Lodi 3691 <br /> A;:pSfta:ion Fcceates i'Y r�--- <br /> i � Manteca 823-7104 <br /> ccrtional tt.-rarna: _�-^� date ��__-�--9 Tracy 835-085 <br /> :it or 'Grout inspection by -_Da•e �%C rr`'-� •a C 0. 9n, 2009. Stk.. to 95201 <br /> n Ave., <br /> Final ir.saet•.fo Y r sal n -rices 15b1 E. mazrl:on <br /> 11 copses .to- Enviroe"er•t ------ " +EMIT UO, <br /> .�l fcan: - .e:urn s ������---r- s;CE:'lEG B+ O tE q 2 Q1l t <br /> LvE 2, <br /> LL <br /> V 5 <br /> iV <br /> is <br /> ,a L <br />