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APPLICATION
<br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
<br /> ENVIRONMENTAL HEALTH DIV13ION
<br /> 445 N SAN JOAQUIN, PHONE (209)468-3420
<br /> P O BOX 2009, STOCKTON, CA 95201
<br /> ,URMIT EXPIRES 1 YEAR FROM DATE ISSUED
<br /> (Complete in Triplicate)
<br /> AppilutlpR le FMreb, Rade.to Sap Joaquin Caplty fir a perNt to construct end/Or Ind-11 the wra btrtln deecftbed. Thla
<br /> applieetlon In sadA to cupllaoce with San Josooln Canty Ordvunee Ra. yto and 1852 and lho Rulaa and Pesulealona or San
<br /> Joaeudn Count, : blle sa:`.M Serrlces.
<br /> F_I7It�/ EE C,,,-=? 11 Stae/Atr.e6e 4-
<br /> JOB Add,,.,
<br /> O.voria Senna Add,., /
<br /> Pnnr Y�L2 y
<br /> /' / <_Apdrei� �•rh r/f�.Lc�l.rc ense No�S�fsa� Pn
<br /> TYPE slim
<br /> TYPE OF sYEl1/vUMP, NEW WELL C WELL REPIACEMFNT i• DES iRVCTON 0 Me of Saralee Yell LI
<br /> PUTAP INSTALLATION O SYSTEM REPAIR ^• OTHER ❑ M rawrift Veu EI
<br /> DISTANCE TO NEAREST: SEPTIC TA f- SEWER LINES _ DISPOSAL FID.— PROP.LINE
<br /> FOUNDATION AGRICULTURE WELL __- OTHER WELL__—PITS/SUMPS
<br /> 19TENOED USE TYPE DF WELL PROOLE!A AREA CONSTRUCTION SPECIFICATIONS �
<br /> C�
<br /> 0 letdeatnw 0 Opao 6.11" 0 MArma, not of Was Eeearallun __ OM,of Was Ca" O
<br /> f 1 DarMa!K rvrwnr 0 GNed Pact (I Traq tsps a Csnng-_-. __ SMEdkstlerrf �
<br /> 1 I P"bk 1'I Odwr Il Dow Cairn of Gan Sed T"e of Gro,I v
<br /> I I IrrrOanon _ Apae,. Dsprh I 1 E.11"n SvNAta SW IntuMd BY
<br /> Rapear Wort Core 0 Type of PunC N.P. _ Slau WOv,Owns
<br /> WN OntrlKtae ❑ Was Dwnawr welthB Mat.rlal E Depth
<br /> Depth Filler Met'7141. It Dep"
<br /> TYPE Of SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION DESTRUCTION I I INo wptK ayslarh pwllMttad it ppKc aewJr i
<br /> LV� "a wave rrlIN.hop loaf.)
<br /> IrnlNSllpn vrM asrue. Reddenu Jy_ Conyrorcrw_ Othe.
<br /> Numot a Of Irvwg Dew:! r A Nwber of y,demers
<br /> tTrKter of we 10•daprh of 1 fw: _%Van.LahM dpdf ^
<br /> SEPTIC TANK 64+T- 0 TypNM'g "--:T acecn Ib.Co"Pen"abou _
<br /> PRO.TREATMENT �
<br /> PLT.0 Method of 1y r�
<br /> lu.! Dhtance Ip ora.nt. Was le Fwxd t. Z/'/ Pro"My Lina ; -
<br /> LfACMINt;LINE tie Y+ No S length of 1 aF �,� '�-r Total 4rptn/aide yI �—
<br /> FILTER SED 0 Distsocs to named. won JA2Fwod.,twn Zti' PrJP"Law /n r
<br /> SEEPAGE PITS LfI 1 DePIh __ Sin _�/y� _�/./M�rmw
<br /> b
<br /> SUMPS K Ddurce to nw,,H: Woe 22 Fpundthoe j1X� Nodeffy LN -.-
<br /> DISPOSAL PONDS 0 .�
<br /> 1 hereby ts"ay that I nNa Watered IMF eppMfelKn rod c.,the wak wIP to done in ACCadar`Ce with.San Joan.. AsrVY pdirtAlfCaa.aYw want,
<br /> ru:w And ngWwlon,d the Sao Joeoum Caunt,
<br /> Nm e Or Iearead Agwli r wgh to es cooden the toao.ving •T eaent,the,e,Ine wo o`anca of the wpe?Is ehxSx this pwrrn 4 Mauad,I thanAo
<br /> a rgPOY env Mao,'In a TarMY as le hKC a M1teocl in Wdtmwi F COT,ahwi n terra of C.6"ns...CaMraKwii ho eg a pIRCpIbKfAE aIpMI Wa
<br /> c.,,fe F tM tospWng:•1 CMtfy that th I.`.a p✓arNnee of th,wnrh la welch tll.a want n I1Mead.I shall MWIoy parears sabw"Io Wnekoven a LW11pif w-
<br /> hen Mews d CMBomY.-
<br /> TM ApP1cArt mu eM IW N move—It p ctiona,Conylaa as++rp en w"es""S"
<br /> Sipnb �' -I,;J r( ? Y C-�.Al Tna' ! DOW: - 77
<br /> � � ,..( F R DEPARTMENT USE ONLY 1,
<br /> AppYestlon Ateaprad iW ._t6�AA��—>i �— Dow
<br /> IN P,Oran trwpacwd,or D.w_ Find ietapeduan �_ Oaf✓ •r/
<br /> Addolond Caneelw`u:
<br /> AFPI:Cant - Rriern all CVPiaa lo: be" Joaeoen L'Vunt, Public Health Services
<br /> Enrlronsen Ul
<br /> health MrRlt/8arvf sera
<br /> e45 N San Juavutu. P 0 Boa 1002, Stan. CA 05201
<br /> FEE AMCONT WL AMCWVf AEMOTEO 1_41,2 RLCIIVEC be ATE "RMI W.
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