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+ t MUM S <br /> rr� �iae.�peMtr�s ~` � "lila-. ,"a"te ,w�sSRa n-e <br /> � V � R�j 1��Y vx" °''�'�°�I��AaA.�Fa�u '�`.tti.r •,�" r ��g1r��� t� �� �� � 1 f <br /> RIY91Trr'•$�' 3tyt��'�° �"��� �ts� f� ° <br /> SANU0A(1UI TH <br /> �w Q K° ft"°sb `k ar 1yx Awa <br /> H0 ¢y��y87�Ck70 <br /> w . P RM <br /> 1 , KImJBedeww++e►'wMi',a.n JapuMj,Counn o.aNw6a f«" «N�•o,�'sfeezhM�Y�lrpu+t+`i�dYtl�t.��W'nA xy...� ds ��'�°�'��a �; • <br /> ;N1 <br /> A <br /> r;t dk`WW _ RUCTION � <br /> TYPE OF.WELL/PUM^_> N WEI = WELL flEPLACE1g1ENT -- ES ra. _ <br /> PIMP INSTAL LAI l0 SYSTEM REPAM .STH FR 2 <br /> !� DISTANCE 1 NEAREST SEPTIC TANK ___ LWEP LINES _ _ _ )lSuOVL FLDJ PROP I WEn <br /> FOUNDATION _ — AGRICULTURE WELL _ OTHER WELL ..PITS/SUM <br /> z '�`srt INTEN - <br /> DEO USE 'TYPE OF WELL PROBLEM AREA CONSTRUCTIONSPFCIFICATIONB, <br /> ><wy Lxknhia - 1:1 Upon Buhom ❑ Manteca :'Dia.of Weli Ex.,nv ar^n `r �Y ar DY d M` t e <br /> tF " - [kmenkr Prrveta G'" Pack C TracyDelta *Type d Casing of O'cu r <br /> p S Pvblle - CtM1[ �' Delta Depth d Grout Seel _ _ Tme of GrnvK „ + <br /> a In pet»n --°,pMoe. Depth Fastem Surface Seal.Installed by pK, y°Na <br /> 1l IR�air Wo'k :or>n TYM of Purnp _ H P __ Stnte Work(Moe <br /> Nel' Destn n', :7 Well Dlanxter __ Seeing Materiel(top 50) --- irl'e, <br /> Depth ___ Filler Material(Below 601 <br /> °E DF.$EP' C WOPK. NEW INSTALLATION REPAIR/ADDITION ❑ DESTRU.,T DN�) INo sePnc mtem�nnttb0 N public r�r Mxe� W. <br /> 01", a+ae'�Ie within 200 heart.!„aw 1-E` <br /> ir'inm1w orr Will wive: Rnaidence s <br /> ,i Comrtnrclsl Other ai � � ;;m <br /> { ! Nvmber of wing units:_ Number^1 bed oom$_�— , f ^v f�,+a yitt <br /> Character of soil to a depth of 3 feet: hQ _�-GlO�fs"z -- Ye+er teGe depth_ S "° wy�y <br /> SEPTIC TANK x' TYoe/Mfg Capacity--/%T_Q Q— 4v Cram pnr•monta <br /> PKG.TREATMENT PLL <br /> -r Method of Dsdcaa! <br /> Distance to nearest Wall �1.£_ Foundation��--.P ops N Lane_ v j <br /> T <br /> LEACHING LINE 3o." Nn. 6 length of Imes _L O Total lersgth/slzelQ �— �� Sr`�'}f <br /> �i ltt kik <br /> FILTER BED Distance to nee�es[ We71 Foundation Property Llnezi <br /> -+ r <br /> V. <br /> zy <br /> I SEEPAGE PITS -❑ Depth -lOi. Sze --- "lumber <br /> SUMPS C Distance to neaesc Well 0.. Foundation G.2 ':Property One_ <br /> "M DISPOt;AL PONDS <br /> I hereby certify that I have pmlaared this application and that the Work will be done in soca Jance with San Joaquin «,nty ora nances ttsre Lave and ' <br /> f l'rubs and regulations of the San Joaquin Local Health District. I shall r of <br /> f Home owner a licensed agents signature certifies the following:"I certify that inthe performance of the work for.whkH the perrrxt is issued, <br /> ray empty any pe.•son in[uch manner as to become subject to workman's companeetlon laws of California. Contractors hiring or sub-contracting;siunet're <br /> fie certifies the/ullowing:"I certify that in the performance of the work for which this jermit is issued;I shall employ pereoru subject to wvrkmsn'a congerea <br /> n{-fir .; ton lea of California.- <br /> 4f <br /> The appiicent must call for aa�ll,rap/uJ�ed inapec ns./CQJmdate drawing on reverse side, <br /> + 5JoardX�v sbsi Tile:,° D'WFyr/ ---- ------- Date _. <br /> r <br /> Y FOR DEPA TMENT USE ONLY <br /> �J Aree_ VLi i <br /> ApD _ar Accepted by Date- <br /> i� — <br /> R< or Grout Inspection by Date_� Final Inspection by <br /> g f �rel si M t <br /> Additanal Comments: -- s s �� <br /> Sri, (666781 a Lod 3643621 an I. 82371tM _Tracy 8.356385 . °� t ntr� t <br /> Applicant- Return all cop�as to Environmental salt') Permit/Services 1 WI E Hazelton Ave P O. Boa 2009. S[k:, CA 96201 "+t�l� ) <br /> INiE AMOUNT DUE AMOUNT REMITTED. RECE ED BY OPTE PEAMr NO <br /> �,. <br /> LSi <br /> aim. , �--� <br /> Y <br />