Laserfiche WebLink
Lj <br /> A( ] PLICATION FOR P$IWI7,} � <br /> "N JOAgU111 IDDUNTY PtMUC EERAL'I'A-.4ERFIC2S <br /> ENVIRMANTAL HEALTH ',OIYIkj . <br /> 2801 T_ HAZIL.TON Fila. . PRWR (209)461(=3430 <br /> P O SOX 2009. STt'7CXTON, CA 95201 <br /> MKIT y <br /> I HIES i fI <br /> (Complete ifl TripIle4te) - <br /> ti*91— lie hcreW tadda,tb Rao 4naduia Cvwty fbP a Wrmit to 1=11truct: and/or inatsll the work besefn tes2rfitgtf. �s <br /> if li'Ltlaro le rted IO aaaplfanae with Bast Joaquin Coanty Orditzmwo No. Shq "a J�$bR =a +be R4+0 .arid Ae'guliou-0—a-- <br /> .3ob Addrssa �? �r # e _ Cary I.et iii:e/Atrtage 7 _ <br /> t Qurr+ r't Kl,me Address CA qq5 l? Phone 0– `t>l.FliE <br /> � � _._._ Ilddress l.iceat i►Isane <br /> TVPIi 00t WELLIPUMP- NPw yujF1I WCrLL REPLACEMENT 0 OESTRUCYION Q Out of Eaa',viee Veil,, <br /> PttMP?N3TALtATION 0 SYSTEM REPAIR 0 OTH" ❑ mbolt;orlrK <br /> CHSTANCE TO NFAAEST.- SEPTIC TANK SEWER f.HM6S ,- DISPOSAL FLI},— PROP. LINE <br /> _ POUNIDATION ,-.,,__,,.._., AORICULTUAE WELL OTHER WELT- f PiTSISLIMPS <br /> INTENDED Uel: IVPE OF WELL+ +�PROBLEM AREA 00N$TRLICTI0N SPECIFICATIONS ��T <br /> I�Tdufhel 0 Open 6attom _ O Manteca Die! of WON lEseflyalLon OW01Die.of Well Carfong <br /> C Z EN"**0C1 Private l:!Grsr,mt Pack /0-- Typo a1 CeeinQ 'Speciticalmns <br /> 1*1 Pll6t:t her t Qalta Deprh of Grow Seat �. �. Type of Groat ^ <br /> ! I tprrgarwn Aro�. Depth t I Easrorn Surface Seat trtarellvd by <br /> oa ' <br /> Raftelr WAA 06114 I] TWW M primp H.P 5►ato Waet Done i <br /> Wan owstiuetron 0 well Diameter � � Sailing Mato-al A DegtR <br /> Piller Material A Depth �= <br /> M OIT SEPTIC WORK; NEW tNSTALLATION I I REPAIRIAODITION I I DESTAi1CTFL?*r 1 3 1No septet syt;em perrnil['ad it ;; ie sewer 36 <br /> aeailatlle within 200 lost.) <br /> 1ptspWtion wilt servo: Asaiderice ConvnertW____ other <br /> flw%t:er 0 11vi@V units,. — Narrrbrr Cf be&aame <br /> C'hsrae,61 at 1011 to i depth of 2 WL. wamr table depth, <br /> SEPTIC TANK Q TynefMfg Caaacitf Na. Car opUro"tp <br /> PKtr. TfttA't#AE SIT'MT.C1 M"T '._ - 1: <br /> Olean=to mareet: well„�,w Fpundariori. f'rgpel�. <br /> LiACMiNQ 1.04 CI No. & Laagth of dries _ Tera!larrglh/ V+ T <br /> FILTrA 810 f� Dfelsnee ro nearest: Wali Faurutatttlrt. A411i114[Eli INTY �' <br /> -- PUBLIC HEA iLTH-S£RVICFS _ <br /> 5EipAliF PITS 1 ! bsprh lSim NMIRON L __ ! <br /> SifMpS L. Qistrnce W naftst: WON-- �OtrnQarinn ,,r, f4oplety Line_–+ �. <br /> DMFOSAL PONDS 0 I <br /> I Mraby cwtily lhet I have prepared ihk eppficaton and that tha wort will be Clone in geeort4,nee with 5aa Joequirt Ceur.ty ardi..xuas, seam rE<l�s.alwt <br /> runt#M raeutetrrn;tat me San Joaquin comty <br /> Ka"owner or kaftead a ani'■s4nstw*Cenifles the iatlowing; '1 COrMy that In tiN Dsrfarrt+aneg of she work lop wtrieh d+is pmftt Is}ruiedr ;!H•e no: <br /> MPtoy NOV Pereen in each manner Is to b*Mrna subiect to workmen's componsation Iowa of California."Contrector's hhinp or wtrcantreetin$egfnstoro <br /> diat the fallowA "I cen;lr that In the pedglrr pce of the wank for which this paraw is Issued.I ahaR anrprpyr Peracrkl tut Matz Tv workrm"'s a6ff plls" I <br /> Iron falba of f:atllorrtif" <br /> the apetieanl muv coil! ►NO quked InsgaClioas. Cornprere drawino an rer.erve sittR. _ <br /> SI{tned 7t��, <br /> Title:�.• Y Data! <br /> FOA DEPA E LIS 1. <br /> Appilvatno Acs tad by 5r 29.0 D <br /> Dale area <br /> Pit of oraut frgw-4on by ,. _ Cara.._,_ Final inr;Pactiorr by <br /> Addhkenat Carnnwntat f --MIAy+' <br /> Afltvwt Retatra All copies tps 9Fn Jargain CogatT ftblie lteaitb <br /> 11mvica9, laarirpataetrtrkt ReulEtt PrrMJt/9arr;0e6 <br /> 1601 E. Easrltoe Ave,. P 0 Roz Zoog. Stoolg%ca, CA 9�RgQ <br /> rf ti ,ilAlilUNT pLi>c AIaiQVNf Ri►srt7E4 CASH RECEIVED BY OATV PEAt+g7'r , <br /> X33-dgrf-- �: <br />