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<br /> III, Olt,rr APPLICATION FOR P bRVIT
<br /> r+' SAN JOAQUIN CIIPUFiL?I' 11FALT1I bERVICES
<br /> F-SVI'IORWENTA.'• 1iFA:, 11 UIl ISION
<br /> T'"A + 1601 E. c:IZELT(,Ti AVE. , i'!f0T'.F 120'0468-3420
<br /> i' 'w, P L 30R ''0(19, STOCKTON, CA 'J3201
<br /> ��,�� ,y�R�•1'''..�F'1Rt�`.����s.lr_:__F_r.�►�JP�',:_L.��i�
<br /> t ' (Comylete in TripllCII
<br /> ApplScatix 1a her-by IN to Sen Jcs�Wr, %rote for a ;er..tt tis canotruct ani cr Saalau tr-e +ork hwreSn des tioniCof
<br /> a}ylice t:ca code In CoT, .S ance tr7-^ Sun ?a,Ss
<br /> - :uaduln Cvw ty Ord:rance No. 539 an' 1862 and the Roles and PaKule
<br /> Jr-v-vin Crinty Pub:Se Nrwl•.a 8erv1^ee.
<br /> - r?,r. � hot SS re/AC rcwfte --
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<br /> Job AAdrsss !
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<br /> ° N -�.�..,� r �' .t' ----'• Phone
<br /> r land,. ...7�j..s.._` -.•.---'' -
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<br /> Cwner'a Name,r...�-.i1� _ Ole��..a-
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<br /> cr Cwd,d;ta /�l:•:L/ `
<br /> '_" r DESTRUCTION L;Gyt of 3eryice -ell O
<br /> :EW VaUL L'rEll REDIA E'.'E rrT III itor 1 nR Well r
<br /> TYPE OF HELLI r1? SYSTE%4 af'PA°r? 07NEA
<br /> otwp ENSI I- 'ICN PROP.LINE
<br /> SEY.f•t 1 ._�- O+SP:SAL FLD_--•-
<br /> DISTI•NCE TO 1'E OtS7 SEPTIC TA',K --- E0 YPITS'SUMPS
<br /> F.�'JNOATION — AGRIrt.LT!aPttiVELL . -= OT,i -
<br /> r _�~ •_.'-_•. 'YF,t OF WELL PROEILE A rEA CLvNSTN UC TION SV CATIOKS
<br /> fr
<br /> :NTfNDE_M 1SF _---- - - - D,a.e!Well CLPMg
<br /> r - C;Dp•r.Oottom CI Manteca U•r. of Weft t,-ava ^_ __
<br /> i it.ndustnsf Ttto of C►srr.i...,.. Spear. ..ons I
<br /> E 1 Gom as'U pl-ate CI Gravel Pace I,Trary Cep'n or G ou Seef Type of G,o,t.-_—
<br /> ! ' i'I P.Inlrc I 1 O.r,.r f 1 Defa -
<br /> t Depth 1 E
<br /> batt+Hon _ lI aston Su t.+c.Serf!nvtafbd to
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<br /> o N P.„ --. -__-.- ,...-- Slate Work page ...._. -..
<br /> f _ 1 Wars.,W rucno•+ u TYof Pump .- ._
<br /> i . e W Sealicta IYtarlr: 6 Depth
<br /> : ^ Well DIanNilaf _
<br /> . lS;ler Material + De^.h
<br /> permitted If Guilt aewer n
<br /> tt1 gEPAIH-APp17 K1hi JS E:.S Pl1C itOty
<br /> '. 1 yl'El O�VOr•` NF,v,NST AE l.A )N //A ava.tJbie wrtMn lOQ feet 1
<br /> .+ l�Comnx•n•I__.., Otho.-._..__.._. -.
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<br /> Installation w q s••`.e. Res•dtnr,t ..
<br /> Nun.i'ef n'14-1-9u^rc Vur„ber of b•deoorns ,gate.tst>4 Geplh
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<br /> 1 w•'to•d• No.Compartments 1�
<br /> • Ctu•acta-r optn of 7'n•t'- --
<br /> SEPTIC TAN,: Cl Mrtrod of Disposal
<br /> PKG 7RE,tTMENT °LT.i1 co,tndaton ..- Property Ung
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<br /> _....-... _....�.f.�.._._....._.._..- Tote lerpthrs;rs
<br /> !fAC+'ING LINE LI No 3 Length of I`res ��s _ j T Propertv Lm• �n -
<br /> rrd r Fw^eaE•on-S
<br /> %vo --
<br /> plsunl.e w rearest. '
<br /> ttLTFR 310
<br /> + SEEPAGE PETS I 1 ')eMh .•_. _ ^---Sire -_ PropartY Lln•
<br /> SUMPS l-r Dnun_e fu nreresr Y•e•
<br /> F ounQet�c^ __
<br /> DISPOSAL PONDS is w,accord+"ce wnh San Joaquin county ord,rances.stain taws•and
<br /> 1 hareby can't,that I he"Mapared this rpd'<atgn and that Ir,r wort w 11 Ire,Sone permit a isau•d,
<br /> I shoo not
<br /> r.. rules end r•qut•Lon4 of I"San Joadu,n Cv,r ty '1 cert., .n the cwrtormJnc•of tn•wort for whrth thn De
<br /> Home ov rte'or Inca=sed arnt'a signature Ce'jf.s min rCale•+•''`g
<br /> "ut.s revved.t lino^.•'ploy p•rsor.a s-bloct to workman's Cornp•nsa
<br /> •mptoy any perwn N.suchas'o[rM ur've wbrevt w wore man's r-p'CenutKn Yaws of Cs'•rornra."Contractor s Rnnq or wUcontracvng signature
<br /> ce^titt•i the IOaOW.nQ''I certify that in the I.alinrrnanco of In*w Nt for w,•;h It W
<br /> hon laws of COMOrnla.•' I
<br /> �UCKKIIII{ Con'"'o draw'•g on
<br /> The appl.tanf mist COlor, e•.Svrrad _ _
<br /> .� .d,-� Dots'
<br /> Tills
<br /> FfI DEP Mhi USE ONLY
<br /> Dare- r•a at
<br /> App,l:ahon
<br /> Accepted by
<br /> Final Irap*ctcn^
<br /> Da Is
<br /> Pit or G/OJt Inspection tv - -
<br /> kr Addittol,a,Comments -.._- -
<br /> I
<br /> CC 'I 9An Jouqulp CountPublic Seal.';h
<br /> Return IIIScrviee•, l�rircatymarul-AGw1A.` pr
<br /> 2uC��.•Stoci_or, CA 95201
<br /> 16)1 E. ESas<ltca Ave.. __ , 1 NO
<br /> %y pnTE PERMIT NO
<br /> I ,h ,r AMOUNT FEMrT1E0�l ASr,TNECE —
<br /> tEE AMOUNT LUE �
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