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.. .n. , t ....r. . <br /> SAF JOAQUI COUN".'T PU3PTT.I C E A!7E SERVI CES <br /> E?-'IR0N-X A`-A,L EEALTE DIVISION <br /> 445 h SAN JOAQUIN, PPOliE (208.)465-3420 <br /> P O BOX 2009 , ST CETON, CA 95201 <br /> !ERA'T?' =ETRM 1 YEAR FROY DETE —115= <br /> (Complete in Triplicate) <br /> Agplieatioo is beret; "At to Geo ,foaquu County for a perst:tt to construct &War ittatL11 the work bercir deacriDad—Thin <br /> LPP11Catioc 11 N"t 1L easpliattce VJU ban JoaQulst County 02-Cinasnee 110 549 ahG 1862 abd the Ru]ea aarC haau]atscoa of b" <br /> JO&Quip County Public kaaltb berries.. <br /> 3rJ 1 J 1 S�a.�F rr SCR - $3 <br /> Job Adaaas 4rp'�4 lt�aQy 4Hp CC�►f/G�I���d/1C City Loi bisc cry <br /> Owner s Noma �A►HA/4 674 I0/t 1� WSULrau �• !J 9 SZD pnoer ZC <br /> CanlraclDt S.i�f �arpriAr rld Add''", r O.Bdr .L License No 68,2&9` Phone 70 7- <br /> S <br /> TYPE OF WELL/PUMP NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION L-1 Out of beryl" trcll <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR D oTTHEER t Monitoring Well <br /> '' <br /> DISTANCE TO NEAREST SEPTIC TANK SEWER LINES DISPOSAL FLD .�;f PROP �a►+�ra,ii��s;,�/� <br /> FOUNDATION rQ1L. AGRICULTURE WELLa } OTHER WELL PITSlSUMPS u^ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> n Inbuattral 0 Open bonorn 0 Manteca Du of ttlen Eacavasron, Ip,+ Ci.r.S Du a1 Wen Damp <br /> t1 Damsslic/Pura@ 0 Gravel Pack 0 Tracy Type of Casinotvt_ Soactllcauan► <br /> 1 I Piiblrr n Other fl Doha Depth o1 Grow Seal 'Y Fcc r Type o1 Grrxi + <br /> I 1 Irrrpairpn Approa. Depth I I Eastern Surface S►el Installed Aq 760 <br /> Repan work Dene U Type of Pump H P Slur work Dona <br /> WON Destruction O Wail Dsomater hea.Ung 1YLtarial l Dept-h <br /> Depth filler Material i Depth <br /> TYPE OF SEPTIC WORK NEW INSTALIA,TIDIJ I 1 REPAIRIADDITIDN I I DESTRUCTIDN I I Ihio sapirc system permitted or pribbt sower u <br /> avallablr wiltrn 200 lest 1 <br /> Instakalran deal serve Rssioetin _ Comrrwrcaal_ Olhel <br /> • NYmbeir o1 in" unite Numbat of bedroom" <br /> Chmsactei of sol so a Depth of 7 Joel Water table depth <br /> SEPTIC TANK Typr/M1p C.Apacny No Ccampenryients <br /> PKG TREATMENT PLT ❑ Mrth04 o1 Drapoaal <br /> Dinanca to newrst WoR Fpunoalion Prooeny Line <br /> LEACHING LINE No l Length of bars loW rnpthisag <br /> FILTER BED ❑ Disunpe to nearest welt Faunoation PtapenY Line <br /> SEEPAGE PITS 1 i Dopih $120 Nomber <br /> SUMPS LI Drtarw& to nearest Wer Fauncasion Properly Luno <br /> DISPOSAL PONDS 0 <br /> I hrretry Conrly tnat I NM praparaC that appiKalron ane This Tha worn will be cont n accorosncs with San Josown county otainancos roti, laws eng <br /> runt one ria urationi o1 or" San Joacurn Cm=%7 <br /> hoar awrrai or iciarmoc agent a b9nalure dnrlwo the ian0wifty "i Cenny that an the parlornfanCe of the wort for wfnieh that perntrt a aaued I stall not <br /> estray any person In well manner u Lr,beCarrr aubroet to wDtsrnan s compenaairon lows of Cshlornaa ' Contractor s hiring or autrconitacimp arpnalure <br /> csnrl.aa thr I*&&WWv •1 Canny that on try penorrnanCe at lnr wort tot which that prtmari n rauec 1.hall employ psraona subteci to wo►Lnaan t carrlaonw <br /> stop hemi of Caalilornaa <br /> Tqr at Jn1 ra.4 n a Compais atawtnp in revers aro@ <br /> sgneC Title f1.- Dal. n <br /> FOR DEPARTMENT USE ONLY , <br /> r e e , <br /> 401:01 12cw% ACCet71@C by <br /> Pr d Grow Irnao.ctmon by Date Final Inapetlron bt _ n-•- <br /> Aadniona CiamH,any r ` <br /> App17t:1h1%1 - lreturr L11 cop)ee tC SLID JoapU7c Count) Yut;:ir bcLltt Ser%1Cea <br /> Lo.trperentL� I+eL1tL Ycrsstl5rrvtcwc s a � _ L / <br /> @lt F SLa Jo.ouir 1 L boa 700E Sttn CA $5201 <br /> s <br /> rrriG wiiOUu' Out I wiiDu*rl RI+aiTIED I C�5• I M[Ctw[D Cy I ^I <br /> iw„�iatV <br /> � <br /> l r <br />