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APPL I CAI A Vit-FOR PER11 I T
<br /> SAN JOAQUIN OOUM PUBLIC HEALTH SERVICES
<br /> ENVIRONUMITAL HEALTH DIVISION
<br /> 1601 E. HAZRLTON AVE. , PHONE (209)468-3420
<br /> 040 BOX 2009, STOCITUN, CA 85201
<br /> RST EXPIRESS 1 YEAR FROM DATE ISSUED
<br /> (Complete iD Triplicate)
<br /> Application ie here.)- ewer to Sat' Joaquic County for a gerait to construct v^"_!or install the York herein described. TL:s
<br /> ap;.if ce.pc•P ie oxer is cow}liance vith ban Joaq.,.,n Co=y ore-dance ge. %5 and 166. W the Rules and At"tions of Sa-.
<br /> JoalcL^ Cou')" Ps:'n l:c 6e►2tt. Services.
<br /> Job Address __7175n E Dine. o^dd City Esca l on Lot Site/Acreage 55 acs .
<br /> Owners Name Ccliier Farms Add tsn 21750 E. River Read Es cal on Phone 838-2514
<br /> I Coe;raao_GARN(F CONSTRUCTION Address 7900 WREN RD, Oakdale Lcense No A-B 441686 Phone B47-3480
<br /> Tl'PE OF VVELLfPUMP NEV, WELL G WE- REPLACEMENT DESTRJCTfON C at of Service Well D
<br /> PUMP INSTALLATION D SYSTEM REPAID D OTHER 0 IbritorlAg Well
<br /> D!STAsr; J NEAREST: SEPT';. TANK SEWER lfaES DISPOSAL FLO. PROP. LINE _
<br /> I FOUN!iATION AGR:CLnRRIE WELL OTHER WELL PITS!SUMPS _,-
<br /> IA'TENDFi, cJSE TYPE OF WELL PROE:EM AREA CONSTI)UCTIO'. SPECIFICATIONS
<br /> tr:duslae.. C Oiv.- 8onon C, Manteca Dr- of .Yell Escavahon Dia of Well Casing
<br /> ::onRsl,c!Piwale D: Grrvt, Pack G Tracy Type a' Casing Specifications �l
<br /> Pvbi,t i-i Other i� Delta Depth of Groul Sea! Type of Gtout t
<br /> It hnganon _ Apn,o. Depth I I Eastern Surface Sea! Instilled Dy 1
<br /> Rope,, Worl Done L7 Type (", Pump H P, State Work Done_ Ci
<br /> Well Desiruttmn 0 Welt D,aneler Seali.`Materia: a Lep:)'
<br /> Own Tiller IYterial a Depth
<br /> TYPE OF SZPIrC WORK NEW INSTALLATION I 1 REPAIR,ADDITION*IKx DESTRUCTION I . INo wvhc system Penm,ttad it public waver a C
<br /> available within 2W feet.l
<br /> Inalarla0ori will retie Residence yCommercial— Other
<br /> Number of avmg units I Numbe, of bedrooms I r
<br /> Chvecser of soil to a slop:.) of 7 iter sandy Water table depth \
<br /> SEPTIC TANK p Typfi�M!g Anthony 9 son concrettspu'ty 1500 No. Cane M~ts
<br /> PKG. TREATMENT = %' Method of Deposal
<br /> Distance to nea!ear. We!' Foundation Progeny Lar
<br /> LEACHING LINE D No. A Length of lines 2 e 100 ft. Tota: length/si2e 400 sq. ft . V
<br /> FILTER 6E0 U Distence It: rra,ast: Welt Ilion I Foundation 50, Property line 25004
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<br /> SEEPAGE Prt5 11 Depth Site Number � I
<br /> SUMPS U Distance to naaesr Well Foundation Property Lar -
<br /> DISPOSAL PONDS D
<br /> I hate.,, efnd) that I gave pte Dt,ed this appL_atior and Ilia; the woot wdt be Dont in acco,caoce with San Joaquin counts ord,rrnces, state pews, and
<br /> rules and reputsi on6 [A the Sen.loagoin C=ty
<br /> Home owner o' licensed sae nits s;y:ralure De^.,fes the lollowinp "I potiey that in the pelo,mance of the wo,k for which this Permit Is Issued, I s1I not
<br /> employ any pe!Wrr,in,sucr rtrnne,as to boco-te WblIrl ID avis kma'•[tom{rnY4nc taw, : Cantor,,, "Cpni,woi s Awing or eubeonua[tng signature
<br /> Cenrf,ra tM toaow,ng, ••1 wrMy that in the pa,to,mance of the wo•k f0hi
<br /> •wch this perm-t i2 issied, I she"smptoY Persons aubp:t to worimon's eorrlpansa
<br /> tion taws of Ca ifornio."
<br /> The sPp!¢an,l�''�.1 ", to, or, I used insxainns Complete drawn o on myerse side.
<br /> ISigno -. Tde.�0=kt oc/ Wta: ��9Ll `
<br /> /� IlF DEPARTMENT USE ONLY
<br /> Applra .on Accaptse by C�n,a,.,_k. O Date —4� Area�p
<br /> ' Pit w G,"t Iruas n:.. bt Dale_-__ FnaInspection D. Dow,
<br /> Add-trona' Com+rnts
<br /> Applswt - Return all copies W: So- Josgnit Bout:y ii Hea:t`.
<br /> Gerrlcesr Z:vrirowwetyv ieaitt PersetyServices
<br /> 1G__ Y. lastlton Ave., P 0 &s Mi. Etocktco, CA 952Zi
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