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l <br /> APPLICATION FOR PSRNIT <br /> SAN JOAQUIN COUNTY PUBLIC ULALTH SERVICES <br /> ENVIRONum:AL HEALTB DIVISION \ _ -�- <br /> 1601 E. HAZELTON AVE. , PHONE I68-9420 <br /> P O BOR 2009, STOCKTON. Cn 85201 r <br /> a� •vn1RE^ 1 YEAR PHOS L,i'1'S ISSUED <br /> (Complete iD Trlpll<b'�eJ <br /> Apsrllcatioo 1e hereby made tp Sao Jw9uln County :or a Fendt to construct end/or instep the vork h,:<: - <br /> opF11catloo 1. sde in <ayli.e. elth Sen Jwcuin County Drd:MnCa No. 549 end 191i3 end the tNlea et'.e <br /> Joapufo County KEllc Nealth Servlees. n <br /> �TAA�yc( <br /> en 0_( �c'rY�7Cd,t yt c.:•. I:dnr.... <br /> Job Add. c <br /> Phil— <br /> OwMi•Nanta s <br /> Contranpl�Cf', Aedrets__--.- <br /> TYPE OF WELL/PUMP NEW WELL C —LL P.—ACEMLNI DES tRUCTION C Ws + <br /> PUMP INSTALLATION C St STEM REPAIR .. OTHER C <br /> SEVIER IVES DISPCCA, F,D.—_ PFIOE' — <br /> DISTANCE TO NEAREST: SEPTIC TANK _ ----- <br /> FOUNDATION AGPoCUG URE WELL ___OTHEP :',Eu= P"5 - '— <br /> INTENDED USE TYPE OF WELL' PROBLEMIO <br /> AREA CONSTRUCTN SPLC':r' "T'DNS D'a. Vf wI .,. _ <br /> (-I InWnnp :J Open Bonom G Manteca Di, of won F.ca.al _._--- <br /> Type of CumO__._ - __ SPeabu:�e <br /> Pubhl , u— <br /> f I Prwue ❑Glayel Pad L:Tary Type of G <br /> ir uEhp I:Olna 110<ua Depthof Glow S.. _.__.--- <br /> r I Inyalrou .—Apleoe. Depth I I Eastsfn Su•laq Sul ill", J try <br /> RepDona C1 Type of PuH P __ __ ST.,.Wort DOM <br /> WIN __--- - <br /> Wah Pump ___--- SI. Wteriel E Depth <br /> Wan Dntruclgn Ll Well D.&.1.1 <br /> Dapm <br /> yill<r wcerl.l a Depth _—�Ne .rr'r.t ,n1, I <br /> .,.. ..,.. -...w.'— ' <br /> TYPE OF SEPTIC WORK. NEW rNSTALLATION f OCPAIRrAOUrtIUN OI,S InuCT'OI' uanden rnn.n h , <br /> InTelfarron.11 wive: ResidentialCvrnm<rc:al_ gO:ne'__--- <br /> Number o1 f",Q untu I <br /> 1 Number ofrna ___--_Wclar table depin <br /> Character of we to•depth of]feaD ---- No, Companmenn <br /> SEPTIC TANK U TyswlMlp --__ Cipacds___._ <br /> Method of D'swr'•I _ - - <br /> PKG. TREATMENT PLT.El <br /> Distartce to numst'. Wetl - FcuMeLVn Line—;6LI-I - <br /> LEACHING LINE 61�No 8 LenpID of sees _ if --- <br /> FILTER BED Cl D'nance to Marra WMI 2?— FouMatron_SS__- Prupmty Lina <br /> _ — <br /> _ �..�.__ <br /> SEEPAGE PITS 1✓Oeptn •mver — <br /> • SUMPS LI P if".10 nMnp: Wel_(_Z-"(,�' . Foundaa <br /> tn _�!�, _ PropenY LIM _�--- <br /> DISPOSAL PONDS CI <br /> __ w <br /> 1"Toby cnrll(hat I nava prepared.Nu <br /> s aVVI' tgn end wt Ina+.,u 1.11pa d 'r <br /> opa .a_.m::ence ,111 San Joeoum <br /> ruNs end repu41ara of The San Joaou'n Co my <br /> 'l[e9'Iv 1Mt rn In! n4of Z"a cl II'.e work to,wn'Or r" ++Jud. el:al'nJ1 <br /> HcvM owner or n inII nimen er as to camlra the lonow„nq „!,..n..' Comranni s n•^ '++"•'q'^I^.I""' <br /> am-file any folwn in suCn my tha as ro eMUTe Wbpcl It wLik"a Aork for <br /> s,inch aL'un 4'nr.' c' <br /> een9ws[M following:"1 randy[Mt in The pedurnMMe of the wort for nmcn tn�e Wrnw n <br /> lion Nw1 0l CSIilMnu" <br /> I M apC!'dan[mut for all req rospetlrons. Compeu dm..rtq m,To"("�s rola ----- _ <br /> S'Gme):7\J/_� sfiif/ <br /> (\� MENT USE ONLy <br /> _ Application Accep[ad EY :a�>✓� <br /> FIT orOrem Inspection by -h+�°--. Date__-- Fmel lnspectP+h, _���--_. -,,• _ <br /> AdAddnicnal Commenu; <br /> Applleadt - Beturo LLl copies to: Seo Joelulo County tvblic Nealth <br /> Servieee, ICtyironm.o•ll Health P-11-- <br /> 1601 E. Hatelton A•e., P 0 Boa 200'3, `• ,KTOT", CA 95201 <br /> rIFEk AMOJNT DUE AMOUNT RLM� TE'J rY SH t"EO a, DAT,— <br /> I <br /> Into <br /> sn.«aa <br />