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FF'Cj1-1 l f �J, 9' _17 . 1P . ti <br /> ONA , -SACRA116ATO' TEL = IC—�s2-c�68 � t_tl:i Cls °'D 10 -,1 tic, .Clot P . -, c <br /> iLPPL I CATI ON <br /> SAN JOAQUIN COUNTY PUBLIC HEALTE SERVICES <br /> ENI V I RONMEN'I`AL HEALTH DIVISION �A <br /> 445 N SAN JQAQOIN, PHONE (209)468-3420 � ��:E—�3� <br /> P O BOX 2009' . STOCgTON, CA 3520 +;• C <br /> pFaMIT1 , <br /> OCT ? 6 192 <br /> ' (Complete in Triplic&te) r. ,.?Y <br /> spp1ic4,t1o2 ]a,hCrcbr made to Sa.a Joaquin County for a permit to conatruct and/or install theme+nt�t'4a�ditiictiei�r`ibpd;-� <br />• appliCaGioA ie made in aaa+spll"" with San JoaQuin County Orrlirtaltee K0. 51+0 end z1�b2 and L1te Ruled sad ReguLatione of ban <br /> Joaquin CaanLy Atblic }lealth trv:cea. <br /> sw tor�rt 0 o� /i h"► rnvwe.� <br /> ' jotsAddre" t✓�iT H446%M09- A4W,6 BLI-Y Cisy $haGKl4N Lot. Size/Acraage _ <br /> jt;,400 Sct,Y-N Gt:'FaTt?a, PMl4[ w+�Y ScJft�31a <br /> bC06 OIL c-04AA pui4AN 1 t.t4 <br /> OwaaPa Nanta ,. Adardtt <br /> r'/"f f17{rS fl0q, , i x7 — <br /> CartttaetaH R4,srtsss �� i,icrnt;e his, phone <br /> 'TYPE GP WELLlPUM?; NEWWELL p WELL REPLACEMENT f"1 Oa:BTfiUGTiQN L1 Cut of 8•r.r>Ce Wallr <br /> PUMP INSTALLATION O SYSTEM REPAIR 0 OTHER 0 Konito " VA_U ' <br /> CISTANCE TO NEAREST: $010MC TANK SEWER LINES "',20 � 0($POSAL FSO PROF. LINE L.. <br /> FOUNDATION .. AGRICULTURE WELL � OTHI~R WELL PITS/SUMPS <br /> INTEL OC)Use TYPE OF WELL PROSLEMAASA CONSTRUCTION SPECIFICATIONS fr <br /> n Industrlfl 0 Open BottomO Manteca Dill, of Well Excavation flit. of Well Casi � <br /> f:1 Doftleadie/PrNrelo twat Pack O Tracy Type of CaelnQ_,. YL Specifications <br /> R 22 <br /> I'I Public I. Othar i'1 Oeita Depth of Grout Seel ._ Type of <br /> I I Itfrgeuon a A00(ost. 0410th I I Eastern Sudecs Seuf Instetled by <br /> Repair Work Q*ne O Type of Pump H.F. Slate Warn pone <br /> f3ealirlg lr,curlal Depthar+�� rxylldt"5 �G�?l` <br /> u Oaattvatlon D Well Dlasnenr <br /> OaAth FiLIAP katarj6A i Depth 0 24 <br /> YYPE or. WQ K; MW INSTALLATION 1 I REPAIWAO01TION I i DrsTRLrCTtDN t 1 (No sepoo system permitted it otrofic uvwr a <br /> available within 2CQ foct,l <br /> ' Instsoulan W4 earw; Flaaidertoo_ Comm%arcial .^.Thar <br /> Number of riving units: Nurnb*f of p8410orns <br /> Character of tad to t 680th of 3 fUtrl: Water tabi* depth <br /> i)♦ SEPTIC TANK 0 Tvp*/Mfg CtpacityNo. C.*Modnftitonte t <br /> 'PKQ, TREATMENT PITT.0 Mllthod of 0400ssl <br /> 014unue to nesrrty. Well .,. 'r•ounaetign Property Line _ <br /> 'LEACHING LINE C'I N0.L Ladgth of finer ` . . __ 70141 tonglh/tire _ <br /> FILTER SED (1 Dlatanct to Aeerest: welt _ iovrtoeNon - _ Property t.Ine <br /> 'SEEPAGE PITS i 1 Npth Si14 Number <br /> StlMPS Ll Mtt mn to nearest: Well Foundation Property Line <br /> DISPOSAL PONDS Im <br /> � hereby oertlfy that I have prenared this appliecion sna that the work will be done in acCordarteo with San Joaquin County ofoinances. elato laws. ane <br /> futet and etgulations of the San Joiqutn County <br /> OMO pvvn*r Om li0ena*d 40ont'■signstvti comiliet the tpibwinq; "1 canifY that in the oarformanoe of the work for which this panni(Is iuusd, I tnatl no, <br /> ef"olOY any pwdarl In such"nner as to b000me evbiect to workmart'c compert*4vQn laws of California." Comlfadtar's hiring of su"antracirng slgnetu.e <br /> censfies the 14IWwinp:"I cartity that in the performtnoe 01 the work tar which thlt psrm;t is ittuaa, i ttieil ornaloy parsons sudiect to Workman's Conlpense- <br /> on laws of California:, <br /> ho stoolirAmt ed 1t require poctions. Compiefe drswino on reverse side,F <br /> Signed Y,, <br /> r w US!~ ONLY <br /> OClicat;on Aapted byg,71r4'F-tTMCNT <br /> nota Arta <br /> It or Grout Ing"etlon by DAN "._______� _ Find lncpoo4on by <br /> ' i ddltbnal Cotttmaftta: <br /> ApplloaRt Return ail copies tot San iaa4ufa county Public- 11valth services r <br /> Eaviroo"4iseel Heclth permit/Services p 1 <br /> ' 44S P San JosQuin. P O Box 2008, Atkn, CA OB201 <br /> fEEr s <br /> A1.tOVNT dt]& ; 4MOUNi f�£1NrrEd 1 , Aj: ZIVEO ay pA7E PfAhar7 N0, <br />