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APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC RRAT ;�1862 � <br /> ENVIRONMENTAL HEALTH UiV <br /> 445 N SAN JOAQUIN, PHONE (90 3420 <br /> P O BOX 2009, STOC%TON, CA <br /> PERMIT E%PIRES :Lj FROM - <br /> (Ccmplete in TriplicaT}Application is hereby axleto Sea Joaquin County ror n permit to Construct andiappliestloo is aside Sn coopllance ulth San Joaquin County Ordinance ao. 549 ann <br /> Jeequlu County Public Wea`lthh SerYicess.. (\��y ,�..nrt <br /> {�l3Ol� N cl Lot�yIse/Atresse <br /> U <br /> Joe Address 7q— - y �An/ K�imnv <br /> Owner'.Name " /C 1 i/ Y 5 aCrees 1 <br /> Centuciw��ll�y���AEEressL�-� L License NgriA..r"�/L?Phpne <br /> TYPE OF WELL/PUMP: NEW WILL ❑ WELL REPLACEMENT n DESTRUCTION ❑Out of If•rrlee Well ❑ <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ fainitorim Well ❑ <br /> DISTANCE TO NEAR°ST: SEPTIC TANK SEWER LINES __ DISPOSAL FLO._ PROP.LINE _ <br /> FOUNDATION __ AGRICULTURE WGL _ OTHER WELL PITS/SUMPS _ - <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> C Industrial ❑Open Schom O Manteca Dia.of Well Escevahon Dim.of WOR Creating <br /> Cl OcmaniciPriv-n ❑GsYel Pack O Tracy TYM of(..lung_. f "611catiom <br /> I'I•4.JIk ❑Other, n Doi;. Depth of Grow <br /> I I Inigarion _ Approx. Depth I I Eastern SvAAc.So.l InslaeaC b, <br /> I Repair Wori Dom L Type of Pump H P. Sup Work Dona_ <br /> Un M-93 <br /> Wall Destruction O WOR Dlematsr 9es11nE Hatarf al LLeptis <br /> Depth__ ylller rlebrlal i Depth enol InenuIN COUNTY <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1 1 REPAIR IADDRION DESTRUCTION I I IN.asy'n� I��a <br /> ay.tlab>tI�R A� <br /> I :mtenaron wall asrM: Residence— Commnr<lel Other _ <br /> S Nv hoo, of Wong units._/.&- NumWr,of bedrc. .—U,4 <br /> Chwww of.oll to a depth of 7 fast: ,�OFJ�E L ,Water sable depth <br /> ! SEPTIC TANK )i.,TYp./Mfg � J C paUry �•CWnporn"rils o <br /> PKG.TREATMENT PLT.❑ / Method of Disposal ` <br /> i Durance 1.mares 'eia4 /�% "r FouMstbn Property Lim <br /> e <br /> LEACHING LINE ❑ No. to Length n• _ <br /> Total <br /> <n xsic T�taSlleeg�h/sin <br /> FR111; / � og —Property Lm !L: 3i <br /> SEEPAGE PAS 1 1 Depth _ Si» Num W <br /> SUMPS '_I DU.r_h:t,to rwiteetl Well Foundation '-operry Lim i <br /> Ir. DISPOSAi 'ONUS O <br /> 1' I hereby certify that I heas prom,a i this application and that'll work will CR dom in accordion U with San Joaquin county ordihanc..,stare leers,and <br /> hulas and r.pturtiorm of the San Joaquln County l <br /> Herm owanr or HcanW agent'.119mtlaa Certifies the 1011owin0:"I t.rtify the'In the psdormanc.of the wort for which this Prim Is Issued.I Shelf nor <br /> mi <br /> eploy any Wall.in such manner ll n moony subject I.workman'.compamehon laws of CNifornb."[consuls hiring W wpWINICling YEKw.do <br /> �1 cart ifo s the tol owing:"I certify that in the perf W mance of the work for which this co,inli Is issued,I shall omploY person.subject to wWkm 's corrlpa - <br /> floor,Issas of C►KWIIle." <br /> i. The apdiewlj // -• 11 rq,,;zd p tt Compau nvnng m r ida. <br /> Spited Det.: <br /> DEPART T USE ONLY <br /> Dau 1 ^3 Area -Z <br /> 11 ' <br /> Applicn Accepted Or <br /> etb6 <br /> y. Ph W Gress Impeetkn by — Data Fine]Inspection by Dab 1a <br /> Add b l Commence: <br /> Applicant turn all copies to: San Joaquin County Public Health 2erYieee - - <br /> /-" Environmental Health Permit/Services <br /> 445 K Sao Joaquin, P O On. 2009, Star, CA 90901 <br /> IL�y/ INF9 AMOUNT WE AMOUNT REMITTED CASH PECENEO gy OAi[ PMMIT'NO. 7 <br /> i :14 2311 IRRV.r..0 � `-Y � I��• kw0/eO3 �' tam IZJIfl�I.3 �5^ef -. <br /> w a I <br />