FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

_ � [akri.l ti.yk l'l tit4 � F � SCAN ybIN COUNTY PUBLIC HEALTH SERVICES XNVIRM; MTAL HRALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 . P Q BOX 2009, STOCBTQK, CAT 95201 T E2=2= 'YAR �RC3�i DA€TSI (Complete it Triplicate) t0a is herein a"* to Sea ,loapuin couatr tar a:perzit to, construct and/or install, 'the wart bsrein deseriDsd. This i• tippiXoati4ss i3 aadc gal 00MISaacv with Ota,ioagnia co"tr OrG3nance sq. I49 and ;8ft and the Rule# #ad Regulasiona of fan i JRIl�tttb COitatp Att?lia 8isltb Bai'yifitir I'. G t1. ,f 0*30 95& roc7cs Jour mss City Lot B#srilAcraaBe c w"Oex l ss. / Y "`fi 12 'r t«f1r kddrogs P. Sr t't/L=tri t# t~ f3 Rte CR+nt►st tor+�it�Ir > '. .4 4N. f ore s V f L.L6 6269 Glcensr oto :§ :� 2� Ph©ns 7th?�� TYPE OF WELL/PUMP= NEW WELL WELL RtPLACEMENT C1 ' OFSTRUCTIN Cl ous of 8arrioe 74W PUMP INSTALLATION l7 SYSTEM REPAIR Q2 OTIKER � ttanitoring Ve � ,SOIL. tSC�tNS ` oISTANCE To WAIST: NX SEPTIC TANX SEWER LINES DISI OSAL-PIC.!4, PRt}P, LINat .,G6�w E FOUNDATION AGRICLILTURE WELL nr,r}" OTHEn WE#.i.!I Plyjp#1 mps LO— iNTENOED USE TYK=E OF%T" PROBLEM;AREA CQNSTRUCTION SPECIFICATIONS fr L ts,ttuatn�I 0 Open Sottas a Mantsati 04. at wail fixt4vatlo+ " } tale.of WtA CislnQ j n Do"soclptivitt !i Grirvsi tick 0 Tracy Ty"of Casing , G i Ei N7 I°UGr lipstifte:tlor* 74 1 I'1 Pttbtla In. t3 Detts t5epth of Grout Sail Type of thou ffdaf i Mripatltwt Approx.000th 13$aetsni. vUrl"S Scut tnetatiatt bytdttS �X-01-OP-Arnold -SftV1 Ery . .. YVarlc bonaja ypi of Fwrtp tp,. stein Work Dano ........_...,._... N Wall Dttftf'iictl0tl Q' Ws>si DWntstsr ...........,. 1n 19aalinp material ti,Drgth Osptt► :t =lar Ntatartnl t Depth f? t 1 a 5 BF SEPTIWORK.:, ;NEW INSTALLATION I I REPAIRIA00ITION I I OESTRUCTION t I {No aepiic system psrmItIv4.it patNte:saww is 4 ' svlltbis ss3lhkt 3ti0 tttRit.l . �!'iStt+l�`01 iktits:..-�. filitrt�r Of bo4ratnst•,_...,.,,,_ :.:. `' iltnw of#OE to i d#pth of Sank: Witirrttbta deg i... * C T,EI+iK. 11 1` sallWtS Gspstsitr- ! oto.OolnpsrOTtf+3ts ...... k9G.TRIATMEN't'PMI,113i Matlsod of 0lepo911 Olitli 0:0410W.' W69 Foundation...:..._.,: tAr+a3t+rta►tial....,..,. _, tEl ii3ltwCi>#.iJ?$ �1 I~to. 3:.J."Oth*fLLtktae TaRsi ertStnttiGli� FILTER NO ta, t3l=tutco toI+tiund�Ilan��. roofftY Link ' P --.•--- Numilar S{ MPs !.1 Distinos to rawest: VVsE:._..._,_ Foundation i ooi*!T I�rtxperty t1ap: ....._,k. DISPOSAL PONDS t I hmtty Gsrtlt'y that i hsv0 Oripilod thie applicstlars sad Chet the Work unit bs dans in ietbardsnce`:`wltts Sin Jpatjuyn CatilitY ordit4ncss.sesta Sarni. and fUlta add riattiaiit3ni OI tRft4:Bari,tasqu;n cwaty ... "SOrrtf Cw4rslt Ot iiestl#ad spusCi sJgnaturs Otr=tfllss Cho tatioWing: "t Certify that In the parioratxncs:;'taf the svatk fat which th;s pernul is Issue I ahid not: urttptcnr inY parson ks,iuch marsnarii to bstartts subj*0 to workRtetr't eetmprnat►tiad tsw: of Cetitdrnis,"Carttactar's hiring at:.avil.RiaauictlnS STiprtiture ertiiilrs Ili fabowing."I carSfy That:in:tihs.pedarmeaek of thr..woek for whkll tlwia porrrsil i,ieeued.!stub ornplay p*r ens 4vbj at to wnrk+tsan'r tom• tkirl W"it Coon"." 1*4 ippgcint 8 All vsttotts.CStirttpteti+ttiwatp on r Slpnstl Tillst 'k FOR tiEPARTMENT USE ONLY fj ( 9fkAtia+t'A COEtsd tsy. Det= J� ✓"� xrrs i; - '4 Grant l" . ..On ey 0stsFin•l lAs Clan b• --w�-- pe Y AddWaniR Carrtrrssnt#t c V r y ADDliaailt Resuatt : 11•.cayle.a: .to:t Baa Joa¢tritt County Public Health 8ervtcas, • iatiranmenta; Nbttltl3 a � - ##b N San JaaQtti'tt, P 08ax 2008. $?eicmitl8ervicetkp. CA'0.$"1V1 ' iNlt AMOUNT DVi 1tilpttNT RitrttT'rttl rs itIICllvtO t"f 4All t[akbllT`.ht0. '