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<br /> APPLICATION �
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<br /> SAN JOAQUIN COUNTY"PUBLIC HRALTH %W'YIC&S ttx/
<br /> SNVIRCINNSNTAL HRALTR ^IVISIcm Ca
<br /> , c `,"',,X'''"+� / 44-- N SAN.:JOAQUIN, PHONE (d091wSS-3490
<br /> P O HOZ 20tr9, STOCKTO6 CL % )301'
<br /> (Complete in Tri-'llcft- '
<br /> APpllcatix Is M»by eaWOe'tp eap Jxquln County r,r a permit to ems lr, and'.- iosOu .lva v k ha»fe doaoribm., 31
<br /> ,r sPplicatiou to all la Coyllence vlth Sen Joequlh County 0,11.. R,.. 549 eni .'tot aad too Rxlar ud ASNWavloMe,K
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<br /> ` I�in County Poblic 8Width Serrleee.
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<br /> job Aoo'. .—/i b g 1 L041'_[�. C ._d1_PtL
<br /> Ow "NM^+._ hLI, :. Addron
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<br /> yyejy _ u N0. 6
<br /> E C "c" PJMP - NEW WELL 0 (YELL REPLACEMI N. 'STRUCTgM
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<br /> MJMP INSTALLATION 0 SYSTEM REE A P
<br /> D S"ANCE TO NEAREST' SEPTIC TANK SEWER LWES DISPO AL FLOP
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<br /> rj FOUNDATION AGRICULTURE WELL r_. OTMeP W20.
<br /> NTEN' EC USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFRA-1OA3
<br /> n0ua,ra 0 Opan Baton O Manta t Ois,of Wee E.csvitt" _
<br /> own.n</Pvvtn ':.❑Gravel Pack :0 Ts:y Type,at Cosin
<br /> rIl Other 0 OWu, Depth o1 Gmue S.W T
<br /> Appoe. Depth I Eastern Sudan....ImNilad
<br /> Pepe,Nroh Den _ Typo of Pump H Pr SelYO,x Done
<br /> WW fHStr,ction _ Wee D4n4ip SW111 a6 wgrlal E Myth
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<br /> Depth _ T11ler wUrfal E Dept^
<br /> PE OF SEP"C WORK: NEWINSTALLATION II PEPAIRIADOITION STRUCTION INO YRtlCryefpn 111404 YM.
<br /> avWabis, 41 n Ntt'I
<br /> .'MMocn vnO Who, P47dth ea� m M
<br /> onm/rcal,��fOthar a h ''r'
<br /> ! �i k�y„r "u^nP,w nl xv»O what._./ NomDof droanq
<br /> 4 'hwwv Of soil to a dpeh of J Nat,
<br /> nrwd?F e1P7r TANK G Type Mfg Csplen'.
<br /> Pk-, `PEAATMFNT PLT C'. VT
<br /> rnpI&wty,,LYte '
<br /> Orevsnc*to iMveat WeD rFourrastr.n.
<br /> v.'<' rc n b.Wt t K�✓.��'i he{ LEACHING LINE d Len-p—tfi of nn �»TaNW1'
<br /> E ^' r.i Dlsunce to rwract. WWI FpundWtwn
<br /> t_ FILTER BED
<br /> j SEE?AGE PITS 11 D.pth _31n ._.__ Noll,,
<br /> SUMPS LI 011tanu to reheat .WWI Founnuloo__,_ 4peely URO ..e..
<br /> . t DISPOSAL PONDS ." O
<br /> 4 I harpy col that I have prepared INS applicatwn and that tha work will M 6004 k,occarlsnctt r SAM J040t h p09v`wV onWW WM,afDEe YYN.No'
<br /> rYr runts Who regulations of the San Jopuln County '
<br /> Y - Hwtn ownn or l.eamad agent's Wpnstuh,owtllrot the totbwinQ;"I ol"FN that It,tM pMormance c' v .row2 IN r+Wftl qJs pwvrlk is allow 1 aff"face
<br /> JJ' employ Why porpn M such novow as to bKome MIDIect Ia workmen's cornpehniwn Ill of CW fo 9 Jto,10c Is Nrsq M vt CpMrSCwq ei4nenPe
<br /> to eanifNs the foeo..Ane '..'I Clanity that M the pdohoeMi of the wo+k for which this peloot 4 4au.0 'I, l Wn,JOy Palatal A'oew N letatt to toMnw
<br /> 1 two lawn of CWHO M�1." �� ,tn f''S t,
<br /> TF.700ee St a raquk}d In Oil d, wkv w rewrn „'i� 's�
<br /> LrS,�h "'� l a>✓'4--Y TltMrl -^.�/ �1 r. WM` h
<br /> F\OR^DiPARTMINT USE ONLY
<br /> i ApnMention Accepted by ='.Itt, OWO
<br /> or Grout Ihspeclwn by __ Dm
<br /> Final IrWNe4on b/f. C5M_L3iIfeL_ZI
<br /> Adana04l Commarrte tea- "1L 0���A'�ES7XayEfi..ill 1
<br /> ACplicAnt No urn All copies to: aavlrotalntaloNaalu1,11O tnN t
<br /> /D.
<br /> l 445 N Sao Joaquin, P O Boa 0009. Dtkn, to 9D201
<br /> FEE AMOONT DUE AMOUNT AEMITTED A/LINED DY DATE SEAMIi 110
<br /> },y�. INFO
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<br /> Yk 0 f .6�lf Y T{aY}ij;�: sY ;Aa` 1 +r' 1 r .+tT dFt Cvd•A it t..y`" 'G t •rail «yrCt
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