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APPLICATION FOR PERlEiT <br /> . SAN JOAQUIN COUNTY PV4LIC ZEALTH SSRVICSS <br /> LNVIRfiAi OWTl.I. LEALTB DIVISION <br /> P a BOX 2009, STOCKTON, CA 95201 F'�:t� !;j;_r) <br /> (209) 469-3447 DEC Q 3 '1 <br /> pERWIT LZM ;.T UB �� t (.•[J":T% <br /> 80yl (Compltite SD Trip2lc.te) p.;r;.IL r,!r.,j?,,:•-L.•,e .c <br /> Apy.lcstsoo is hn•ehy sasfe•to gra Jagl•la County for a yxreli •a cOaetr;^t ,.adlor install 04 tart ieT it"dricrsded:� +'lttls <br /> spyllcatioe is asdt in convllarce vlth a" Josquls County ordirArc• Dr.. :Ly uAJ 1*.62 gad the Rube and Regulations of Batt <br /> Joaquln Count;• 4%b14e Braltd 9ewieaa. <br /> JW Atldrew Mo ._ ISC•(/Q City '4+4'VrX5:�� rea <br /> Lot mac/Acse _� t <br /> O+a+tor'a I:An+a R Ckk4 M/N�Cl 1,0`1 vcf&7 5{�r�14�+ 950/ plbne filo' O <br /> 5 as,r+ect r►� G S'SP 7 <br /> Ard,•ss t. ri•�rf�[ cense No. ,�J2Zfi Y Pnar.e_ <br /> TYp' OF WELLIPI)MP NEW WELL ❑ WELL REPLACEvENT I-, DESTRUCTION Out or s•rrlc•Ye11 <br /> �. PUMP MSTALLATIDN C SYSTEM AEPAiR u OTHER L7 Monitoring well <br /> ' 3r <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES SO DISPOSfL FLD. PROP.LINE <br /> FOUNDATION 2C� AGRICULTURE%YEV OT;IER WELL PITS/SUMPS .�.. <br /> INTENDED USE TYPE OF:WE'- %AOBLEM AREA CONSTRUCT:ON SPECIFICATIONS <br /> n Inoustnat C1 Open ocn,xn~ ❑Man1Ka Da. cf;Map Escswton Die.of Wso CNinq <br /> Is t]arrestc/Pn.eto IX Gravel Pr.•.c 0 Tracy Trp*of Cswng se-L% PJC Sprulieal,ons �e`� YQ <br /> I.r Public 1-1 Otrit Ci DNI& Deofh of Gaut Seal Sur '-t _ Type of Gequt <br /> d trt+Uatron AS+,>rta. Dt,j:h r)Eastern •'rfi+co Sae]Initialled by <br /> Roo4w WOra Done Ll Type of?c.np H.P. —•_ Scate Wor Dcno <br /> Wig Dnvt,rtitan 1� Wig D,srnsler '#'t Sealing Material i Draih <br /> Depth 30' £ 1lller cl.tar:al :4pth I� <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 0 AEPAIRIADDITION C1 DESTRUCTICN L= trip&epl,C s„ste:'+WNT fled d Perbl,C aewor a <br /> sva::awe w,:n:n 2W feet.% <br /> Installation wig sant: Aesiae.rr_ Commercial— Other._ <br /> Number OI Wing ur•.itt:_,. Number Of pedroome <br /> Character of sol to a deprn of 3 feet %valor tatlls doNh <br /> SEPTIC TANK A Typo/M19 Capacity No. Compartments <br /> PKG.TREATMENT PLT.Cl Method of DiapasN <br /> Distance It,noore7t: Wall Foundsuon Property Line <br /> L:ACWNG LINE Cl No.&Lar.Ctn ul Tinea Total Anpth/siss -- <br /> FILTER 11ED 0 Durance to neseasr Wen f-oundouon Propeny Line <br /> SEEPAGE PITS I I Depth S:•e f-umbo+ <br /> SUMPS LI Dislartca to Acre&!: Well Farndal;on Prup"tine <br /> DISPOSAL PONDS L) _ <br /> I heret/y conrty that I he"peepared this&ppleCstepn end that She work. —It be d vn&M acco,canee ,In San jos, un county Oed:'K.ncf:,e:ate taws, end - <br /> rules s+d reol."rior-t of the San Joaquin Cruuty <br /> HMT!owner Of keneed agent's srgneluta carblies the ratio—rig. "I :srldV that to;he >v.-Iorm&rCo of the wort to,which Lha prrrrvt is ensued,I shall/LOT - <br /> ampioy any person in such manner as to t»Come subject to woeim&n's coeriWIJ,sn•rws of Cot-torro&."Conuscloel turino or sub-contracting sicnature <br /> Canities the foaowing;"I carofy that in the pertorrnonce of the work for wh,ch Ila pe•rrot a is&usd,I anal en:play persona subject to tw ItrAon's cdrnpans&- <br /> tion trwg of CalilDMLe.- <br /> The apOki rat u9 for M!rpwrod n4wl,ont. COmplets drawing on rwe:se s 01- 1 <br /> Signedx__. C� _ True:-__ 6,46n�N� _ Deter <br /> FOR DEPARTMENT USE ONI'' <br /> ._ AM-k-ateo-%Accepted by ✓-f- - ----- -- - �Z_ 0•le 42 I I !I Atea <br /> FillcmGrout Inspection by ' ",Jf� � -' Datr rl�//�/ Final Inspscl,on by �� ''(r'`- -T�r JCyn <br /> A3tll[ixt&i Cwrvrtants: L. !_- 1 --I <br /> ��.•' Ll� <br /> . aP;_Sctst - Returs sll ccpie& tot SAN JOAQUIN tf'OUecrr_rr:tL1C YdALS'Il 3WtVICEs <br /> Fay X SPH JOAQV:N. P ! bC'ai1 DUP, VTl:lt'KTQe, CA <br /> r'Ii0 AMOUNT DUf AN+OLIhl AE/a`tltTfO I 1A$ R[CyIIYSD fir SAT[ �y fiFlkwT No.., <br /> .tX 13N IRtY..rr sr }iI �+U`1 C) f fr`amu ' f cl <br /> � — I7C7�'� A:111 !I �� ���3V <br /> .. <br />