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Fu,,
<br /> .77
<br /> ssurH
<br /> (2�9) 465-�,78, onTL
<br /> IT
<br /> ?Camp1pte in 7rip)Ir.a.ta)
<br /> for a Pe-It to constructwe"I"'poinp
<br /> je 3, N,.). 18Cy fcr
<br /> Ln e pan
<br /> q81117�h County (�rdinance No. 549 for sew
<br /> ,4)dquin LOW San Joaq1jAf`
<br /> rmoe in complianCe With
<br /> joaqwif Local Oeal
<br /> Ve,
<br /> Sut3j��.Vjs4lcn Name
<br /> _Z3£[;.. Address
<br /> er.se NO.
<br /> WELI. E?tALEMEM1 !_i
<br /> L L
<br /> Tmw
<br /> F ICA'I C
<br /> AREA
<br /> F of �Jell E,,,,at�o,
<br /> '7
<br /> 3.,�n 160ttom Marteca
<br /> Of well cas!"
<br /> rIve
<br /> 'I Pack
<br /> 1 1
<br /> G
<br /> c P va D17 ra5inC
<br /> P,stj
<br /> S f i r
<br /> _atjons
<br /> of Grout See'
<br /> -,yoe of Grout
<br /> Seal nsta 0 ed bY
<br /> q. SurfaceSe
<br /> state work Dane
<br /> RP of PLIMP I (top
<br /> , ajr Wr
<br /> , D(�F,�e ,_ Seal jrq Material
<br /> AP0*5 t, r C �1� O e
<br /> ' , FJjer Mmteri-dl
<br /> rmitt,.d if public sewer
<br /> is
<br /> septic tank seepage P•.t
<br /> availatle with-'n
<br /> Ntw T ION
<br /> tHo 1
<br /> Orr
<br /> twA ,dance _k, Lo-
<br /> quinber of bedrOOTMS
<br /> Xg on I t5 No, cognpart"rkt5
<br /> f 3 feet.
<br /> Capacity
<br /> of DIST,40'
<br /> ��.Paclty
<br /> prop#.rtLine!
<br /> foundation y
<br /> t nearest-.
<br /> o
<br /> Total
<br /> 9 perty
<br /> rRUC ON
<br /> A.ength of lines
<br /> oul.
<br /> nearest: Well
<br /> Msta,I ce to __ Nvsrber
<br /> Size
<br /> o-pvnt
<br /> 3 ,,e trj
<br /> nearest: Well
<br /> 01ist
<br /> cardance 'Aih sa ft joaqu4r' :Ourty
<br /> D Pm, 'W111 be 60fie in ac
<br /> hat the work for ,A i C n 0
<br /> DjstriC'-"f,,__
<br /> ��Av.rp� of the work,
<br /> is
<br /> prem tt6s aPPI lcdt'o�' and Joaquin Local Nei,t
<br /> _t have Pl fy toot ir, the pe comp once
<br /> law�, of ta Jnr"I certify
<br /> 'by e, 1 Y tra, I tions of the Sar P sttj�ct to workmdln� t.he wor�
<br /> rules 5nd regu a t6e rollOwIng'
<br /> laws, and �, ignaturl. f: , the perfo�a
<br /> certt ie,' tQ became o)"!,I -ertifY tt)at"r
<br /> 1'tfl,.5a1j aqel�t Pvrs0` in "ch man -Pia.
<br /> ane owner ,<r ',hall n0i nature erti.fies-the fo'!Ow)n(3� atior lay's of C llfo
<br /> crkr,8!1� coq"�`e"s
<br /> g or 5,UD drawing
<br /> on reverse side.
<br /> qerson'� S"3er
<br /> �lall "
<br /> ve equire6 iTlsVectlos'
<br /> Lontplete r 7 qtk
<br /> RTM
<br /> I— Js� Owl
<br /> FOR DEPA Area
<br /> f Lodi
<br /> ..,p,i-,ti�)n 364-352
<br /> Acceptelj by Mant B23 7LUz'
<br /> ;dd I t i �na55
<br /> 7 T
<br /> 9520,
<br /> ,,,F,Ctjon ry
<br /> bel BOX
<br /> -ttn
<br /> by it/sery
<br /> ina jAea
<br /> rl
<br /> By
<br /> REM�
<br /> Uc
<br /> lo:
<br /> T
<br /> 3-
<br /> .......... .........
<br />
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