|
Al'YL 11.R 11 VP rVn roma.
<br /> SAN JOENVIHO ENTALPN
<br /> BEALTH DTVI "V`CSS
<br /> I N
<br /> 995 N SAN JUAGUIN, PHONE (209)W8-3420
<br /> P 0 BOE 2009, STOCKTON, CA 95201
<br /> �apDu IT F�pII�PS 1 YF 1R PROY ji,�CJ:a���
<br /> (Complete in Tripllecce)
<br /> ,tpit�tl Pa ft �A�le�eoi�•^tA J�hv�°tJ4O9v,noCeun Oral n•ne•nAoryl54,9 .r,E/o1862 "A3 tM•RVI h� a•Nl.elee• o[ Mn
<br /> .nan,u. Co q Nolle P.ILN C'Iv�JLL y
<br /> .aJL.LIf-/LZ+�S.T.Loc SIN/Acrerl5•
<br /> Pnm. y g� sb
<br /> 0�'. N.m.
<br /> f G _ Aon,"s
<br /> CEnluctel Yl.CCI ifr lel �_—A,Etet, -mLlla1
<br /> Tr PE OE rVE:L/PVMP 'N[W U
<br /> WELL i] 'NCLL RFPL>CE MENT (1 DESTRCTION ❑aT °t8tor11,S+JL�L n
<br /> SYSTEM REPAIR U OTHER G
<br /> -- PUMP INSTALLATION G PROP, LINE
<br /> SEWER LINES __ DISP05AL fLD.�—
<br /> OISTANCE TO NEAREST: SEPTIC TANK __ _- OTHER WELL PITS/SUMPS
<br /> FOUNDATION _--- AQPICVLTVRE WELL
<br /> INTENDED USE T/Pf.Of WELL PROSIlM APFA CONSTRUCTION SPECIfl_CAT,ONS Dr.01 Was C.•N,D _
<br /> n M.m¢. OM oI Y M E.aolcn Q
<br /> 1 own Smarr Soculk,tats
<br /> f1 po,r,.ItK IPrMI. _l D,.s.l Pad n T,.er T'M YI C..vq_._—' TYM d Gram
<br /> 1'1 nRfe O 0~ n"is D.om o1 dam S•N _
<br /> _E.PpCI.Op,n 1 Ess", E•Y111L'f Saw Ina•..•E W
<br /> SIR..Wort D°M
<br /> 2 P.pIk VN,rt D°rr G S..l", Iri.rll A D•To
<br /> WM pt.RNconn 1 WON OI.THm - �-
<br /> '
<br /> [ tn I113o
<br /> ApIhurlu E D.Da.�1rPC C SEIOC YICai.: NEVI!NSTALLATICN I I REPAIRIADD:IIDN'W�Dt%ERIilT10Jl ant"200IM.)•��I piO4C•���
<br /> Jl N.,Y.mn rrL,rr.: h.•:M,cP 00w
<br /> NY.nD.r d ti'W,R'w''-//- HwM.f d b.dreo'.•.- _-_was,uDM dpin_-
<br /> CNErolw d 1cI as.%Wo d[N,.1: Sf{,I I n
<br /> __ [!DICEY No. Lorrlp.nPMN
<br /> r: S[PTIC TANK O TYy./1Mp - ANlnoe Of DEtpoIN
<br /> PRD.TREATMENT PLT.O
<br /> ' Dk.i,c1 b r,Nrl.c Vial-- FavMalion__— P.op.M Lw
<br /> Al
<br /> 10,14 nJluP- -- -
<br /> LEACHING LINE QHS L"tn of[net 91-1- -7�R
<br /> FIVER BED O pmrrl b B04I WW _ Fwrwlton `Sf �'°DErtY Lin,,, —
<br /> NYm6•r r
<br /> S[[IAOE MS 1 I Gwh _ —S1°-
<br /> W.nr�b I,..rMt W.' Eoai:cation�_-- PrlywtV LYr
<br /> SL160►S LI D '..L.
<br /> DISPOSAL PONOS O .
<br /> .0 I h"W e.rwr iMl 1 Nal put N:t1rN.pnY tT,and Mat IM wo t w'IB D.Eon!n.:td0•MI.,h S.n JotgVN,e0.nIY adI W,eM,Iuu ln.I.avW .
<br /> rW11 a.,0 rIpYY'wr d Ow filn Jo.quN, Ca,annvV
<br /> Her!,.D.U,Ir a Scsr,n10 pt•0'.Ilpnitw OM folow+r,B:"I clYlh,tnY'm tM plHam.nc+DI lM rrnrt IS,r./Ikn bry p.rmt I.•.,,.0,111,11 MI
<br /> III���" KQlpy/Ity pPrwl,N MK11 rrlY,rl.r M b IMfMM.WJI•tt b WwtrnEn.CdTPs��NIIM IbM d CN,IM'W.1 14By nIt MY1D M wDCOnR.[iMQ tIB/JtYrE .0 y
<br /> �1 PYf In OM pMIpTM,r.01 IIiI NOh 1IX M7'IM.. �.p.rrnll N YwO,1 4vN 2rtWDY 0•rEor,•wDl•cf to MwYT1n'I ca,S`.nEE .F.
<br /> pO lC41W : cIrDIY
<br /> d CMo.ry ,
<br /> y: TM,IMRc. /!.!Iw I n yKun C . �/ Q
<br /> - ' \TnL: ` •A` t � Dau all
<br /> POR DVARTMENT U7C ONLY f
<br /> Data
<br /> ApDRc.Don Atewt.E
<br /> „, FJ411n.wc40n by Dnl ,c.c�
<br /> � PR w Oran h,•Olctlon DY Dau
<br /> r 1,
<br /> AOeltbul Ca innit”r
<br /> Ap Dllc.Y[ - tntarn all eoLl• to: [.vlro.rvnt 1 RultD P"mlr /Rork:.leen
<br /> 1, .. 445 R Ban Jo.RYI., P 0 11o. 2000• Stt., CA 05201
<br /> [1E AMIXINT MwYOI»aT RlMITI[D CASrI RICIIVID.r DAT! PERMT NO.
<br /> �I 93— oa Se
<br /> 1
<br /> s
<br /> t
<br />
|