|
'f SAN, .30AQDIW}18CQUNTY PIIHLIC'.,HSALTS :�'F�EVICSS'
<br /> "�: NiYI$UN_ !sHTAL.�HEgI,TH,DlVISI�
<br /> 445 SAN `J Awix �'PHO14 -�(209)46$73420
<br /> �. g _p-gpgi, 2009�*STOCXTf NA ll= CA 95201•
<br /> iF a ,. � .�r:Kty. s?` K •,e of ,:. -+
<br /> � Fi^: • 5' '1' � A M :�*4f�,'. � �.�L'.� '2 p` r:�El i�F,3 -
<br /> �� " d�T EgPIRSB45 1
<br /> YEAR FROiId DATE ''ISSUED N
<br /> �yyx { " a � sr •� . '�{,Cblfiplgete, in Triplicate) f{
<br /> 'i
<br /> i?fR3�aty t.t Y; d
<br /> ApplleaGlon 1a',dareby„sleds to S. Josquin�lCouatytar}2a permit to construct sgt!/Or 1astall the work bereln described. This
<br /> Jappllcitionais.made in:.ccW11ance: ti�th sR doaq'i 'Couaty Urdinance 80 549 sad 1862 sad the Mules and Regulaisons of Sea ;
<br /> .Loa a County Publie-Sea}th 8errlcea„` „ ��*
<br /> _ ^ ���ir^
<br /> JotrAddpsr `ED%!J[ . YYL� ,:. City S�CkiZ�i� Lot 81ze/Acreage! Zea K 2 '
<br /> CoN
<br /> owr,ei :+T►4 SF+nI oAthL
<br /> - a I C:Arm-6 L.t GC
<br /> k
<br /> Con 1(44t P Lt�t��m +�GY�c[n�i ddress $a2ST`C.IM72fL� + Sf License No , Z 8 Phos B 4,< 712-
<br /> r ;i
<br /> �JYPE OF WELL/PUMP .NEW WELL z�. WELL REPLACEMENT.P , DESTRUCTION Q Out or Service Well ❑
<br /> ply
<br /> PUMP If+IS3'AI,LATI IV"O3`�` t s SYSjEM REPAIR _ f , OTHER'17 Nossltaring Yell
<br /> pISTANCE TO NEAREST SEPTIC TANK`? �� SEWER LINES
<br /> x. ! y q/�
<br /> .:.n , RISPOSAt.FI-D. PROP, LINE
<br /> s „«,,: �...;. -,E. ,r , FOUNDATION ? �°r AGRICULTURE WELD �© '=OTNEA WEtL -PITS LIMPS i
<br /> INTENDE4 a�tTyPE OF WELL�� PROBL1tM�ARE+4 �CONSTRUCTION SPECIFICATIONS
<br /> nflndustris�` © Orri Batt ' D Manteca , �Dia. of Well Excava ' n °� Dia�'o}Wag
<br /> r TRK
<br /> -,Dorr»st alPrj il�t�i r J� rGrsw) Pack >. � Cl Traey'.'} r` ;Type of Casino v'� ' s 3 Specliications
<br /> I'I 0� ►t+qf `n Debs �P� Mpth of Grout Seal. t' `Qi .T Pe of GroutNLYH?- C.�ir elj i
<br /> { ON,lrtiQ.t nJ G
<br /> r l I Irrl at $L h n S E�
<br /> p fort �* s '.APproa. Depth k Pastertl Surfsca Sass$Instal bbr'
<br /> a Repair Work Done `L]'' Type of Pump,. Y.•ti” _ ' '`.8. `a, 1 ..r S i
<br /> }. #1 P#. tate work Done
<br /> Well Dettructbn O Well Oiamenr�' } Bea #ag Y4teriwl i Depth
<br /> ' sY€• i r; x-Depth i ... .F . .. ;. T} ler 1lttteFlal Deptb ' x�,:ter ,., ,
<br /> K TYPE Of SEPTIC WORK NEW INSTALLATION 1 1, REPAIR/ADDITION I I DESTRUCTION I i INo septic system permitted if public server is
<br /> 'cr.i6F�'" r• rA:. r5; evadable wlrhln 2W feet.I• -. ..
<br /> " xlnstailatlon will serve P t `
<br /> s Residence , Comrnerclal % 'Other
<br /> r "s.NIltl�bef G�Ifyiy unit- • ',, Number of bedrooms
<br /> •. �d
<br /> s °-;hak,Ct�i�I roll•w i nitzs[A=:I�.e k
<br /> =sEPTli
<br /> ' h :, h Ilk
<br /> PKG ,1 Post-It'"'brand fax transmittal memo 7671 #ot pages ► i s� 4. �' �. ;i
<br /> c e AIjOi1.
<br /> JA From �': ilk!, £+. R, �� 1
<br /> w O�C+CI++r !C I�JOA
<br /> ^� Co. QUINCfJUNT
<br /> I.Er ACI-.
<br /> Co P �// � �:€�" '+ 4N� � ICES
<br /> 1t Dept. Phoneit ' 7'T T !
<br /> Fil. E y proPenY Lina
<br /> Fax# _ Fax#
<br /> SEEPA l .R '4_ ,I�k.� Number 4�
<br /> ' l
<br /> ;St1MPS era+ �i LI—Plstanu to�i�tl.it '�"�,WRII`"�I""9��"" 1 �OundEllOn � �� "b Plop@M Lina
<br /> DISPOSAL"PONDS Z 0'.,-'
<br /> t *: I k�� «•° .:. l ,, . . _
<br /> I hereby cirtlfy`that'I have prepared thi>f'applkatbrt and that1:rlie work will be done In accordance v lth San Joaquin county ordinances_, state laws, and i
<br /> ;ruk+s and regulations of the San Joaquin Couatir wr, t , x,.;� �d r
<br /> Float owner or Ilcanua agent's signature artlfiaa rft.follgwing ''!GarEify'lhar In the parformance'4f the work for which this permit is issued, f shelf riot }
<br /> employ any person in such manner as to baeorxte iubpct to workma!%I compensation larva of California.".nContractors hiring or subcontracting signature I
<br /> eertdletti aha folMwing te,��certify iMt in the padaretisince of fhi yrorkl for which this permit Is issued I shall employ persons subject$a workman's campensa
<br /> trop laves of Ca fornia
<br /> The applican at call ar ally . M e
<br /> 1 Or". k i drawing ort rover" aids.
<br /> Signed '` 43 Tlili: 'c R s'O,�3' Dat
<br /> w` FOFJ DEPARTMENT USE ONLY
<br /> gg /
<br /> Application Aecapsed
<br /> by
<br /> eFrL x Date
<br /> Area
<br /> I,f It or Grout Inspectlort 4y... at Final Inspection by Dau
<br /> Additional Comri;enee: "✓ " :: E I s E-� `k'� f. rX " ;
<br /> s`Applicant.- Retura all copies Lo, SanfJot gtiilR Cunt�:;lPutrlio flaaltb $esyicea G "t
<br /> 13aviroalapatal >Iea1Lb permit/8ervicee, a
<br /> R ," r • r 443H Sari}oaquirt;: P d Hox 2009t t3tltR,J t7A3301
<br /> i w F
<br /> NFO AMOUNT t]t]E ' ;!►MOUNT RF.trtlTTEO CASH $' AECEIyED NY. pATE,, . PEAMIT'NO. S O
<br /> F"M211 ji,
<br /> ri�A � i,c.._e.G.+.^<r4w,:,,76�e�.xr�:ar
<br />
|