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<br /> i, APPLICA7,ON I'Uli PER11IT
<br /> CAN JOAQUIh COUNTY PUBLIC STEALTH bBRVICZ5
<br /> LNVIRONMENTAL HSALTH DIVISION PAYpAINT
<br /> P 0 B3X 2009, STOcKTON, C., 95201
<br /> (209) 468-3447
<br /> 11CiitL4) S/,T';1fFiei . Cr'l+JNT) t
<br /> ktiOWptnte 1Tl TrS.. >'W] +r r. 7. - r
<br /> ApyliCaLion in hereby Ode to San Joaquin County for a pers..i to c)retruct and or S�a•a.le{�t��of�Vwe� lnr��er �SThia
<br /> a appaicaLiet: a sesdr in cuaplisnee with Ban Joaquin Courty Ordssutnco Ito 549ranc}.h62 ahG tt'• Rules taad l�eL�L►tiar�ti F�F�
<br /> Joaquin County Iyailc eaalth Serwitea , � �
<br /> x SE ++Cir-Nf P k'C I,,�r'cht C+� STOCK`fON Lot 81aerAcreeae U`:2VOWN
<br /> Jop Atltlna - ^ -- ut
<br /> SANTA FE PACIFIC ggg SOUTh FIZtUERUA STREET "
<br /> t c C 9nn17 Poona
<br /> O„tr,�aNa,TM
<br /> PIPELINES Adtlress
<br /> 212 PILOT AVE
<br /> corer no28�`s1C`xL Phone
<br /> Com-acts, nnn_S 2ULL�1dG CO _Address �AKFRSFIcrII_--�l+�330.� '-'
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<br /> • TYPE OF WELLIPI,MP NESY WELL j?.K RtPLACEME r,ESTRJ:.TepY 0 Out o` Sar+rlce Nell r ..
<br /> PUMP INSTALLATION C SrSTrhi RtP'-,R - OTHER Z) Nionitorins Well C7 I �
<br /> DISTANCE TO NEAREST SEPTIC TANK 1jUKUQWN- SEWER Lt`JL ISH�N9 tiL _ DISP7SAL FLO --- PROP LINE -
<br /> ' FGLfhDA710N 11HKI1InWN AGRICLLT,IRE[YELL �,,.rr.Krl�_WSYTMLR LIELL PITS/SUf-4PS
<br />' INTENDED USE TYPE OF WELL PROBLEM AREA =ONSTRUCTIO_, SPECiF-CATeONS
<br /> industrial ❑open solum 7 Manteca O a at VVIII Esta,at an_SL— U'A of well Cas-W F' f
<br /> I yt.r n1 Caa,h r $pecil%&Wne
<br /> ( Domest.cJPrrwte Cl Gravel Pec► _I rracf g--��— AW UM�F —
<br /> A PI+W c 1 th L7 Delta Deolh of G-nuL Sea _ Type o!Grouf,� t
<br /> J Irrry)alron CATHOII� ,ON_
<br /> PUMP Sl 4tRRY_ S}�(( 6 Tt
<br />' � A ■ t ,�Eastun S�.1aCa Sa i Ina-.ed by
<br /> rRepair Wort Dons U Typo o1 Pump i M P 5 ate ,n 3r6L Done-
<br /> - wan Oestruedon O Wou Ouma as
<br /> 1 aeellna K.terlal i L+ LY, __ `I y:
<br /> Depth Ani+ filler listerlal t i�eYth �
<br /> IYPL OF SEPTIC WORK NiW INSTALLATICNO REPAIR/ADO 71,IN�., DESTPUC,ION [1 taro aaPncirslem permitted If ptrbl.t wwef y
<br /> fill
<br /> ay.�taDle wtlnin 2013 last I
<br /> Irtataaat+an vrrU Diva Res4ente— Commerce+ - Orr er —^
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<br /> =K, Number of Irving units Nt rnbier of ba4roorra �-
<br /> . - Ct+araster or sal to s aveh a!3 ria ,. watrt- ubNa depth 1
<br /> 'SEPTIC TANK `d T"1Mlq CepalrtY_ No Compartments _
<br /> S
<br /> s'I PKG TREATMENT PLT C MatnaB of O,sposN
<br /> Distance to Mlrtrst Wren Fovndaho, °ropenY L
<br /> • 1}',,_ LEACHING LINE CI No 6 Length of Iv as - iotar.en9m,
<br /> FILTER BED' S"I Distance to nearut Wali _ Foundar,on Propane Lana
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<br /> SEEPAGE PITS I t Deptri ____S 10 - NumLer
<br /> . Jo ry
<br /> $LIMPS L' Oratence to 0016106tW
<br /> raat IN
<br /> OISPO::Au PONOS CS
<br /> .,�•y,-M- t hatat)y Certify that I have wippered this apWKar'on and Thal Ine work r-t W dune,n acct/-dance with San Joaquin county ordrnanCss atata�laera5 Said
<br /> ruiss and requlatar+e of the San Jorvu n County
<br /> {�A Hofna owner or licensed agent a Hgnature rendes the follow ng tan Iv Mat in IM Ca r,Orm Jn�e at[hs want!ar wR+Ch this pefmtt u ruuad 1 shah n
<br /> 'efnptoy a+ny Gerson in such manner ss to become si zo wori,man s componaatfOn lar.a of C&,,Orn■ Crnuactor s hiring of sub conuaCtrng spnatu+e
<br /> carttfraa the foeowrnq I Cortef,that x1 IN&peRrn
<br /> orance of Ins ww c Ipr r h-ch this Darn-[Is+064-0 1 and f e 7tptaY pereOM aubFaCl tC wOrttrtan a CWrtpartea
<br /> ^'rlion Iowa of QWOWIS
<br /> q ' The appheani roust ut too itad ct+ons Complate drawing an reverse side (415) 429-1724 11L =' '
<br /> r _[te t Oats 9/14190
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<br /> ry, D C JeffraryY.� z FOR EPARTMENT USE ONLY I .
<br /> Application Acepted try _ �
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<br /> I- {x Pit or �Ft
<br /> Fafalrtepeetron bV w � , Oa• /r (GFJnaI inspection by '' Dace rC
<br /> y s � Addrtbrut Com+nsnta �2�t.r/
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<br /> 'j Aimlicaat - Retur'a a.11'copies to SAN JazQLIN COUNTY PUULIC HBALTN 8yRVIC6S 3
<br /> • LNVIRLh MFJ,TA- 11LALTIf DIVISIC-4 1`kfUI1,T/3I:hV1C89
<br /> ` Y 44,% N SAN JOAQLIN P O J.III 00V !f-,LiCArON CA 05201 ' s
<br /> Fri, yM'dUr-T 00! •!MOUNT ft'MiTIFD I �", RECFn ED ev DAT! PEhMT NO
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