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Aug. 13, 2007 9 : 11AM A cad GeoEnvironmenkal No. 9447 P. 7 <br /> sAN .YoA@UIS COUNTY PURL ' �t�k+:"Il� SFs&t�U xis <br /> P [ }3tD 209, SrTOMTON;, C4 95201 <br /> 209) 4C,&-31447 <br /> T. <br /> (CumpleGe in ;'riplic8,tOlt <br /> vork <br /> Applic%tion s. hereby m&do,to 9- vfthuSL 0"'n C_ <br /> CcuntYrO dincncevit to nlroru5lyct EanCo7'8ii2tiarlthe efiules epdeRegulatiOnfi Of na <br /> applictiGion is made in ctanpl / <br /> JoFtiuta County Fuhllo Heslth ©Grvicdk< ,J+J l � _^ <br /> Lo't Si.&eJAcrci @ <br />` lab Addfess <br /> lel � --�X7 v ft�� Phos i 3.31-. <br /> Qwney''%Name te}ts' �: 3 <br /> br Gr TTJLCr4e NO.r+34L-��a�.. PhOflB <br /> Contractor '�, N Addrasst1 �" �-- <br /> �l6lL REPLACEMENT C.l C�ESTRUCTIQN Ct Out ar 5arvicC Well <br /> TYPE OF WEt.L/PUMP: <br /> NEW WELL otrvt,�r�g Well r i <br /> PUMP 1NSTALLATICN 'Ci SYSTEM REFAilI C) <br /> SEWER LINES _ - nigPC}S�L F.LC3,_-- PR P. LI <br /> DISTANCE TO NEAREST; SEPTIC TANK -- � '� <br /> OTHER WELL F1_31S1a'iCA <br /> FOUNDATIONAGtatCUlTUiiE WELL - w--� <br /> �- SPECIFIC.AYIQNS <br /> INTENDED USE TYPE DP WFLt. PAoBtEM ARFA CONSTRt1C71ilN II Cec1n <br /> - Os. or Well EYCavalion ��� Die, of Weq <br /> open 9O11Um <br /> n a <br /> [] hAa SOC <br /> krrdu%Criil Y � $peufitKttone <br /> III a of Cseili T <br /> L3 Pomti%tacJPrivale Cl Gravel Patk C] Yracy yp 9�-�- <br /> M Pktbk f l O+har <br /> ID Delta Depth of Grout $eal ..._ Type of <br /> r-1kril}arion --.Appfox. DePlh C 50$11r!1 Surface Saul instal}ad by <br /> Repair work Done 0 Type of Pump H.P.-- --_ Sato Work Done <br /> materlsrl 6 Depth <br /> wait Destruction Wait pi@mete! Sesling <br /> Filler HaterL*l L Depth <br /> i D+pf h --- — � <br /> TYPE (1F SEPTIC WORK: NEW 1N57ALLATION L1 KtPArgIAOOITION Ll "DE5TF;LjCTt0N Cl (No searic sYM412 permined it public Sewer a <br /> availabte wiISO 2iRI fsal l <br /> I <br /> I installation witl serve, Residence - Gommercibl Othar !- <br /> Number of living units; Numbar of bedrooms u ._ <br /> of 3 fent, �� ---�..............�'�-.Water table depth <br /> Character of 6911 tP a depth <br /> No. Corriortmnnti _ <br /> t SEPTIC TANK C1 Type/Mfg <br /> PK3. TREATMENT PLI, Ll <br /> Distance to nearest: WWI . Foundation Property Line <br /> LcACHiNG ONE O fro. & Lent th o1 ireu T01M Ientath/sita.`..­�- <br /> pILTER 050Cl Oisssnce to nm are%t; Wolf Foundation-_ _ _.,. - Property Line - ---- <br /> i _ <br /> SECPAGI Pi75 I I Depth _�SiSe .� ���- Numbe• --- <br /> IstJMPS t} D;uance to nearest! Weil__-- Founttetiorl.__._.,_.�._ r Property Line _. { <br /> j DISPOSAL PONDS 0 <br /> E 1 hereby certify that i have prepared this aPPlicrllofn and shat Ina work wilt be.dons in accordance yri;h San Joaquin County nrdinancos: Mete laws, end <br /> (Vies AM4 rogulf0on3 of the Sbn ,]osQuin Coun%• not <br /> I !tome Owner or licensaa agent's%ignaturq cenifles 1ho follpwng. "i Cdrtily Chas in the ty ri4rrn2s;t:s of the Werk for which tt`ia permit is Issued, i %heat ure <br /> amptoy tiny porton in such manner as to become aVblecs to workman's comoonsativA IAWs o{Cltiitprniu.".CantrQrsor's hiring or sub cvmractinp aign8ture <br /> i work for which th;&permit li 10400, 1%hall ampicy pentons subject to wrorkrnan'a comoonse- <br /> carlilie6 the fallowing;"t certify Mat In the parlor-4-111 0100 to <br /> tion laws,of California." <br /> The applicant must call for ale jnquired lr4pectiotw. CU!Tlplete drawing on reverse ko. <br /> +--- <br />,I <br /> Signed �. . <br /> FOR DEPARTMENT USE ONLY <br />,i �_. �___ ..� ---.- Gate.__ms.µ <br /> Appllt:atiort Accepted by - �' Ates -.... <br /># Pit or Grout inspaetian by bate ---- Final Inspection by-- -- Dma <br />{ Addidonsl Comment%, _�•- � ,- . --� -"�� '� <br /> i AppliCttrit fieturu a3 L copies Ln: SAN JOAQUIN CQi111TY PLiBLIC HEALTH SERVICAS <br /> E! ENVIAONMRNTAL EEALTH l)IYX$ION PERMIT/SERVInEs <br /> aos N SAN JbArUIM, p 0 1:+QX 20Qf�, JTOCKTON CA 002UI <br /> rEt ar�5ps!NT ,f Ernil"fELr m fK RECEC�ER BV rsArE PEgnetY N0, <br /> AMOUkT DUE CASwAE <br /> I ;• rw Y:.'n If 6V tin}l� - <br /> 1 <br />