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i <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC BSALTH SERVICES <br /> EW I RMIENTALHEALTH DIVISION <br /> �n 1601 B. HA26LTON AV ,. . PHONE (209)068-3420 <br /> P O BO1 2009, STOCKTON. CA 95201 <br /> 2X"jT aa1R S I I AR FROM DATE ISSUAU <br /> (Complete in TrfPlicate) <br /> APPilc&%.Im 1. IMnsr Rod. 19 Baa ..L via Cowltr far a peratt tc caI•tr % andior 1e•tall the varR he"In d•arrih.d_ -h1a <br /> aPpllntiee to a.do Is coMilasc• .flu am JoaQuta Cosy 0r171laraa Mo. 54 WW 1542 " the Pvier Spa AaAulAtlon. of Sea <br /> Jowls County Pubug Bealth BervlImo. <br /> Jco Add.•A _. filJ_� •P�E.g rta _ _..r. f+r -h*1A JLZ&.) L,% a4ss:A:.rra6e <br /> O.nw'.Nvin n, i•1C'S A_ (r� r/ AOSeaa _. _. Poona ?_ -37�,5'_I <br /> Coni itla =AL 1? 6. lt1CdA ba'est _ .}�, t}b64 Jam' ' .OL6l�ct�te 0.a S '�'37G p•.o�r fk•r'35+7� <br /> .VPE OF %tLLI►jVP NEW WELL WELL REPLACIMV41- Il 01,5114"1 ON 11 Out Of so"Ic. Vol! L <br /> PUMP INSTALLATION = SYSTEM REPARA LI OTHER ❑ 1b01wr1ra vol, LI <br /> DISTANCE TO WEAREST. SEPTIC TANX SEWER LINES ,.___ DISPOSAL FLD.—..— PROP LINE <br /> f*UNOATIQY __...-- AGRICULTURE WELL OTHER WELL PITSISVMPS <br /> �NTtNOEO USE TYPE OF WELL PROeLEMAREA CO.45TR1wCTION SPtCIFIZATIONS <br /> (� uy..a11.Y ❑ Opan Bona.n <br /> f:--M Dr of WON Faur•1w1n _.. Cie d Wa.Aarq <br /> I OaMtet'PllwIt Cl Gnvo Pao. L- T•ICV Tvp.at Cary. - — 5080c 4110"f 1 <br /> P„pAr I ' o"'Of t-' D.I,, Doolh of G.OJI S” TVDo at rnovl �• <br /> Apfroe D•pah ; tosmn Swrau Seel IMl•RW tv _. <br /> Resew Wo b Oen• L. TV"o1 P.nnp H P Stna Woaa Dene --- <br /> Wer O•vw w :'? was 0w w Baal iAE Nat•rial E D.ptJi <br /> D� - Pi:l.•r I�t•rial t D.pth - <br /> TYPE Ot Sf PTIC WORa NEW INSTALLAT,ON RFPAIR/ADOITION - DESTRUCTION I I .No f.pLc .vsl.rn p•+If..itfl6.f PllOac w..rr n .�y5 <br /> �4A r. = W1A.W Ont~%7E10 fort I 11 <br /> MR4461dr..0 saM Av"dow • _ •f.M.nMreW _. OItW ` _ <br /> NUAMW of weq utww —L ffur'rew at aroroonr <br /> Cwac1•.or we ro• AaDtll of]aeri taLT.T' C LAV - Watt uoI• o.ppl --� <br /> SEPTIC TAM 7 TVpvw, PtLi _ Caoac•H—fin_._ No. Colreomnonta Z <br /> ►ILO TREATMENT PtT CI Method of Doss" <br /> ' 0fafrte•to ne•r•a Way .g__ F"t vA Prowv L." — <br /> IEAGNWG LINE e NO a L•lyth d W. _.�I.=1 �' _.- of <br /> FILTER BEL - O.uanw a. neeteat. wMI /Qe Fonoae -Ad Pfwomv Lu+• <br /> j SEEPAGE PITS I I Depah . -Sw __ _ Ny bvr <br /> SUMPS 1 1 O.ataflos to neerwt Well - iwnoalwrt ,. PraprN le.. <br /> DISPOSAL PONOS 0 <br /> I hw"V [.fats Mai I Mer Drop~"We OPPK•wn 8w6 that 1ho vra. +.- IIA 600.0 M .ccaoeK.w.ln Sw J000wn a ntv p6r. ". Ara"1i.As. and <br /> oats one roPulsimIes of the San JO.iu.r. C',eakr <br /> ' HOT.0*M*,a bewo"•Cara.- we ftnlr n t..a 1911~4; 1 Ialoft"I n 1N P. *T Aftca of 1P. ft to whra rtes p•nr.1 a**,*a. I ww MI <br /> a+Ipk)V.r.V.a..in w.Such...Mwr M 19 OacoT.WISPICt 10 WOtI.TrI't CanMna+Tlen Ia.e•d Cr.larr.• Cenv.cra'a hlr'lV a s.IPCWa•..;hn0 ayrah.le <br /> c4la4N IN feaawelB 1 10%va ker.w.e co rlp~ <br /> a Waal d Chan. <br /> The apof.t.n.r.wl W lw <br /> a.R Mo "r""bor.s come""oww" on ra arN ha. <br /> SyrrD x. T.Aad '" �-� __- L•1. _! <br /> t FO)( DEPARTMENT USE ONLY <br /> Ap.acOtwan Acupled s, . Den / ZL��••'g 1 AraA <br /> P.t a Gratz IrlapaetYR p Dan FAa tMpaGa�OV ` .5.� tea - �� <br /> A46Rw w[oRal.ant. <br /> ^ Aw"caut - R.tura all e9piw to: Bap Jowls Caoaty W►i1e Raalth <br /> B..-vterr, A1vfe cvtal IlAalt.h hrRIV34nict6 <br /> 1bDl i. aaa.lt,ea Ave.. P 0 Bas 2009. St9enton. CA 9W01 <br /> ill zowlwT DUE AMOL:a1T REM:rT[D R aftt O.r DATr rlRM�f MO <br /> I-NFO` CAS" p <br />