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APPLICATION FOR PERMIT <br /> SAH JOAQUIN W(jNTT PUBLIC EiEALIH SERVICES <br /> ENVIR0NYBHT.4L HEALTH DIVISION <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> !209) 468-3447 "• ;. <br /> DATH ISSLIHI2 a' <br /> n <br /> (Complete in Triplicate <br /> ,'� AypllMtloo it M1•tti,o"..W 8`a Joa41uia County for a pervat to eon.trust tad/or inat&u the wort bertln daa�rlbe of TrhThis <br /> ne _ - <br /> aypllcauos is Is"* is ca*liat with a&Joaquin CvQn-y Ordinanc�e 110. 549 Ind 1862 and tbt Rina@ and PeauL <br /> Jo.quls Coeay♦u"a seal" Mrvicts. <br /> >( 11200 Moncure Rd. �„y Ripon _ Lot Stile/lcrow <br /> Job Addeo• , <br /> B d B Fanns27011 Austin Rd., Ripon _Pt,p,. 599-9 <br /> r'• <br /> OwneNarn• AGdraK -- <br /> Hennings BRos. fad-tJi 3525 Pelandale, hod. L,ctnat No. 2900813 <br /> Contract*( <br /> YPE OF W[LL/PUMP: NEW WELL� WELL REPLACEMENT n DESTRUCTION O Out of Ice Well O <br /> T ►UMP INSTALLATION C SYSTEM REPAIR Ll <br /> OTHER D Itoaitoring W11 <br /> OISPOSAI FLD. PROP.LINE <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES F PITS/SUMPS <br /> FOUNDATION AGRICULTURE WELL OTHEP WELL�L-- <br /> PROBLEM A.REA CONSTRU -^--' <br /> INTENDED USE TYPE OF WILL <br /> � <br /> CTION SPECIFICATIONS u Y <br /> O Mont. D,&.of W Excavation �a of W.8 Cas+rq <br /> C7 IndutthN O°P”'50"Msteel SpechfiutlOns a <br /> Type of Caamp— vV <br /> U 00"Wtie/P""" ur"Ovo Peck O Tract to of Grout Seat 501 Type d Grouf��u Qnd I j -17t <br /> C]Public 11 OtOer O Data <br /> Depth <br /> - - ���Apprca,OeWn ❑East.rn SvAiu Sad Insuutd by <br /> �(krrpeton <br /> H.P. State Wort Don* <br /> C Repair Work Done U Trips of Pump Se4li,4 M►teTial i Dtpth <br /> WW DHV40OW O M Dwrww <br /> . Daps. Tiler Nsttrtal k DtV-h <br /> TYPE OF DTIC WORK: NEW INSTAUJ.TION 0 REPAIRIAODITION t.1 DESTRUCTION G IND aava,Iable thm 2 Wr'TMflb d public wvver a <br /> N whVtin 200 IMt.I • <br /> Instaf4Eioa va»nA:' flee sera, _ Cornrtherc,a_ Omer <br /> Numbs of kVIIIhG WiM__ Numbv of bedrooms <br /> . __ Water 1.able depth .. <br /> Character of fatal to a depth of>fw: f:•,.Compactny^ts <br /> SEPTIC TANK O Type/Mfg Capacity` <br /> Method of Deposal <br /> PKG.TREATMENT PLT.O c <br /> Diaiancs t0 MarKC Wel <br /> _ Foundation Progeny Lint <br /> a <br /> Total Ienjth/size <br /> LEACHING LINE <br /> Cl No.a L.ny to of Iinei <br /> FILTER!EO Q Daum to nwsst: WONFoundationProperty Line <br /> SEEPAGE►ITS <br /> 11 IJeptf+ Sirs Numt er <br /> x.. SUMPS U Distance to Merest: Was Founaatbn ProW*tY Line .. - <br /> / OISPOSAL PONDS O <br /> 1 herebygasify tett 1 Pevs p•P•rb thisapW.cat.on and that the work will too done m ACCrdance with San JoaQu,n co•�nry crd,nances,sure Laws-and <br /> runes and repubtpM of the San JoaGun County 1 unit that In the rtorrnance of Ina walk for wroth Ma Perrnt is issued,1 shalt not F <br /> Hom•O++rner of Kartsed•VK�s w9natura urt,fNa the 1040W`n9'.' r a <br /> armploli env peradn in such fnarv,er as to become wblect 10 wort.man's componaa n yw►of Ca1,II Lh& '• ploy cto�`tnp ort too-workman's ccornpensa- .. .. <br /> eartlflea the fosowmp:"j eerffy that in the perforrnence of It*work for wrurh Uus permit <br /> ,a oeued,I✓Wt.employ a subject _. <br /> tion 1"A of GamorNs' <br /> Tha epplK+^s must Ca for a•rpured in+PRcuons.Com�aeta drawing on revere +. <br /> s.onhw Hennings BRos. Tills: By t Da.: 3-6-91 <br /> t l FORD P MENT SE ONf,r <br /> ' 1 Dau Area <br /> tpyuatwA A..pted W <br /> Dau FvW InapacWn by Dau <br /> I Pk a�titvvE)r+•V+�'by — <br /> ..,-.f AddtiahM Corrrrhenta: .,r- � ' <br /> al c ot SAN JOAQUIN <br /> THpllIrC" <br /> AppL'�t Return kIOa1DfAy YALTValON PRIT/8¢RV10Ea <br /> 445 N SAJI JOAQUIN. P O BM 1009, BTVCZTON, CA 95101 <br /> ilf AkaOUNT AEMiT1ED ItfCUvEO a DATE PE1t,.til NO. <br /> Aaa(r�rNT Ol/f CAS', 144_ <br /> wF0 `la D <br /> "1 -Q9' 7CG7 3 r2 •qt. q� .S UJ <br /> .� <br />