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n APPLICATION FOR PERMIT s�„.\'
<br /> t SAN JOAG'III! COUNTY PUBLIC REALTH SSRVICRS Ay
<br /> -`` x i EDtVIRONIEENTAL IiSA1.TS Z3It ISION YFNT
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<br /> p o Boz 2009, �TocgTax, Ce 95201,
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<br /> t (209) 408-3447 z ? 't
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<br /> PUBLIC
<br /> JOA �. r
<br /> 7 ? - T •VBtj`` YUl�C i r
<br /> (CompAatf: to Triplicate) ° RONl1�FN NHS UVry
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<br /> Application So ltgrwby mrd. W San Joaquin County for a peralt to ccrostruct mWor Install the uorl b•ralq dtra2F3+l1lIDl
<br /> ,+ J uln Coon v Rrdlnance IIo. 519 and 1562 slid tAe that* and Peffulstlogs a! StiYR
<br /> •� HK < appllcatlon fa tirade So compliance with San oaq t,
<br /> {+;;7• J—iv.ga Coto *alta Serv_cea. A Pj
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<br /> City Lot_ Lot SlaelltreaSe 1: f
<br /> r3 a x e Jo0 Address N,, '4 m r.....
<br /> p,u T �.,r Lb. Add•.0 0 Pn°'r
<br /> ' sj r Orvrfera Ntwr!]i► i�°tu
<br /> 011.
<br /> I,.�, fes' Caelt,{a0r AQdreSl Li{t'lt!NO. �f�+' PAWMs ¢•box µ r
<br /> TYOE OF wELLlPUM.► NEW WELL f7 WELL REPLACEMENT CJ DESTquCnOti ❑Rua or Sertric• Well
<br /> , . 4:.:: Ilon!tor!rd VO Is?
<br /> ti SYSTEM REPAIR t 1 OTHER p a`. r
<br /> PUMP INSTALLATION O
<br /> W»b DISPOSAL FLO. PROP.LINE
<br /> +x t' DISTANCE TO NEAREST: SEPTIC TANK SEWER ONES 11:K
<br /> r` r FOUNDATION AGRICULTURE WELL"— OTHER WILL PITS/SUMPS 1SD. v r i ter
<br /> INTENDED vSE TYPE OF WEIR PROBLEM AREA CONSTRUCTION SPECIFICATIONS l „
<br /> n IntluaurN- --.N d Open!loRom - Msmeca D.A. of will E.c,va,�gn'_ /[ Dia.of woo Co -
<br /> ,- _�11C Spec ncstwr+a Seh. do t,-
<br /> R.:+ Y ?w r¢dDomrr�ticlPr+wle ;D[Grovel Peet 0 Tracy
<br /> TrDe of Gsnq
<br /> 'ty r fl Pubtie ,, 3 1 i Ocher Q OeNs. De^M o!Grout Seai SVQ> Cf� ' Type W Grout #r+
<br /> AWoa.Depth Q Eastern 5urtio Sart Installed by - •" -
<br /> T o!►until State Wort Dwte
<br /> flepeir Wort owd "L7 ya• K.P. z
<br /> +. 1--"i - Beallr,2 Mlaurlal i LeptA �..�..r r
<br /> WM Ogxm tan O ti WON Diemelsr. j�C! s
<br /> Osa+t1 �.� ]ills: Mrterlal Z Dtp7h
<br /> y y'1 G V.Y
<br /> TY►E OF SEPTI[WORK NEW INSTALLATION 47 REPAMIADDITION CI LrES7RUCTION G 1Na s•plrc wstttm petwwtoll A a+t}IK sewer+
<br /> x l ew+,we wrlhin IRR feet.1
<br /> \p Syf lu
<br /> { "x t 1 f _(MleaallDn wi NM RM.denea�.,� (,OI1Nryx{ial^, O,r,er Ysl`r4
<br /> r r i t r, « Nilrrlbrlr oI Gvi+g UrMi Number of bedrooms
<br /> ` - .-. 'wat11 ladle MDth
<br /> C1wWw of W1 to a deoh-o!3 feel:
<br /> $r 4y SEPTIC TA7dKJ Fv ]f TypelMlQ CepacrtY A Na.Cornpar�++eitta b, Pry
<br /> wr PKG.FFTREATMINT PLT a 0l Dwpwel r .FF Y�j4
<br /> DiitanCa t0 neareal: Well FOWf4lliOrl Properly L1ne .. .. :4-r + •k`lr "_ ,rx' " "•-
<br /> c s LEACHING UNE Ll No.A Length of WWI Total length/alt. '" i,t•-
<br /> x- tires
<br /> ++ FILTER BED, f C1 Distance fo nasrest: wan Four,dalion PropartY Llrto
<br /> ' eta
<br /> SEEPAGE PITS I! DeDth _Size
<br /> Number " rte°
<br /> SUMPS
<br /> f'' L1, D'utanu in rwresl: wen iound,r on 1'rt}pe.ty Lina A r
<br /> +' DISPOSAL PONDS' 0" F .
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<br /> f hereby artily tl4t a leve pr,parod Mrs tppLcalgi and that the work will In QOM Mt or.'Ord,nCe with San JOapYil)C"Aly pQrMMea slat.f11r/e,tlrldb .r
<br /> rules and togivulions of the San Josouin County r +� r }t
<br /> Hornet owner a licsinead agent's aignalwa prtrr�et tM faaovang:"I{arPty lhei in trio yerrormanc+of the wort fa which erns permit its
<br /> iieued +� -
<br /> - @nVioY any Swoon Mt such manner as to become subrecr to wwtman's tompamssi on taws of Get,tania."Conlraetors hrrir+g or sub-conmrscfinp¢prtstYr• , °'
<br /> unifies The fpaowrinf;'.I CWWY thsl in INva pa,form,nce of the rrO k tot whrcrr thu permit is uwed.I INA OM010Y Demons 1014- t•,rVWMman a Gorwpenaar r�r.�4.;�•,..,
<br /> . 'tion Ilya of CaFilomis.`:.• 's _ .. - - - 7 ' r m -y;i..A ;tf
<br /> The spp[irjnt for•ea 1 .Corr+plel,drawing an rwarae We. r '
<br /> i; S/dpi.
<br /> Si3nsd Tills: L i Dele: % tYrj
<br /> FOR DEPARTMENT USE ONLYr��i
<br /> ,�-� Dat. � 3
<br /> Appksfion Atcepted.be M
<br /> t L 'l Final lnapatt ah DI►le
<br /> -FIt'«Cuotrt lrteprct,on by '"'• /� ,• .�'7�7''.«a.7 �.c,�'''n,{'
<br /> l.dditbnaf Corrvne+tle: <'w .J 1 -
<br /> '}�,,t - /� .Appllcaat 1lotxrn.al.1'c'oples tot SAIL JOAQUIM CO,Vff 9IIiLIC HiALTV ECRVICAS % ,., , •fir, ,r+`r '.
<br /> 1 >,r CNVINONIjt"A.L %LTIt DIVISION PLAMIT/SCIIVIC>CI,-I'-
<br /> NS M SAM JOAQUIN, P O JIM 2WO, asTXxTYMr, CA CSnR!
<br /> ►[T ,µKURT fM+E AUMNT w{µtrifO a{[Irv1R a♦ DAT= - :fArt•7 Ivp, .i'' ..' rear}'+ •,
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<br /> .� 1+"' r- - �1 .r-cost►-d vv��,,,rv�yy,'rkx kl�..! f
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