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05:2 91 11:53 e415 8Q. 8303, HARDINIG L•lITSO <br /> s AT`� x]002 <br /> W QUIN OOUNTY PU13LYC EMA,,TS S iCsS <br /> ENVIRONMENTAL LMT9 DIVISION' <br /> 1.601. E. MAZELTON AVE., PROD$ 1(209)468-3420'!. <br /> P.0 BOX 2008, STOCKTOIN, CA 85.203 <br /> E=11 E32IRES 1, YEAR Xf%Oi[ DATE ISSUED <br /> (Complete is Tripiicmtea) <br /> applieetc.Lell 15 kerlqby Mede to Salt JOSTsl=, C'Q= ty fors gest to coaettvet iad/or Lnatall :As vary herein described. Thio <br /> 4wlicat.Loa is sSde 1A =V114s=ee V�-th z" Joaquin County ordiita ee. tio. Sky, and 2.8Q sad tbA Rhes& sac ReSQlArt(me of San <br /> 4(*%V1n Catutt3► R=Olse f{ca.LsL servicaa: <br /> Job Addmss 4 G i i LLIP ti city L i an F.o; &1'relAe;reege �' <br /> Ca�u r+ ++ '�=1t 7c _ AaCress ItLI-A,. f1o.;)1c..i _.,a. ur.. P},one <br /> owner's kame _ <br /> centracw <br /> 1 <br /> C'S - �,I2:s .•uG-fir�� Cseisic� 5� 9'4`1 7Lf 915 �I7-7 ?� <br /> - Address License No. 15hatta <br /> TYPE 4F�R! Fla*trey NEW L WELL REPE.ACEmEKT G DESTRUCTION ❑ Gut or 3esrict: �Te�i Q <br /> 1 ren ltgr�tYar:lt$ Neil <br /> PUMP WSTALLA ION C? SYSTEM REPAIR 0. OTKER C1 [3 <br /> r <br /> DISTANCE TO NEAREST. SEPTIC TANK 1QNO� SEWER UNE$ � ' OISPQ$AL FLD /aO `; PROP, VNE 2100 <br /> FOUNDATION 6�.`� AGxir-ut TL3liE WELL t� OTHER WEE.I_ ZL PITS/SUMPS <br /> iNTEND90 USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS tet,r(ny � tf <br /> C] Industria, -0 Open Bottom Cj Manteca Dia. of Won Ez=V*6 n�. ;Die. of sing <br /> C1 DamestielPrivate O Gravel Peck ©Tracy Topa of CttainQ - 5oecifcationt <" r A�et ji � <br /> — <br /> l'1 PUbIIC 0 Otrw , , c n Delta 0110th Of Grant Seal Type 4f G/OuL sn�-^� r <br /> 1 t irtyia=loet � "~A —aa. Dapt#�i't� `aa�s nG Sudace Seat Insualsad by <br /> Repair Wart page b Typo of PUM0 State Wort t3gne . <br /> well Destruction C3Wetf Diprnataf Sealing liater:etl a< Depth ! ,. <br /> Depth 14►ts`�iel a Dem �-,Q� {c ��.,A=%i 1 al G�c -*G�.�r+'�CG <br /> TYVE GF SEPTIC WORK: 149W INSTALLATION I 1 RI=PAIRl�4.D01il4N L I DESTRUCTICN E I intro septic iyststn parmilltd rf iXg aewet is <br /> atrsllable witJtin=fast.l <br /> installation wet sefva: R66denee— Comenerelet— Otherfes,\ ` <br /> N4ffgw of vying%36441:�...� Niarnbdlev <br /> 9r of t» m J \ <br /> Character of 8011 to a depth of 3 fist: f w'=tar We dentes <br /> SEPTIC'LANK. 4 TSr�IMfg 4 � pedL�' �.,,� o. C-0er►Dartmsnld <br /> PKG-TREATMfAly PLT,L-1 Method cf OiSposM <br /> Dista to nor 11 un Property Line: <br /> LUCHING UNE ❑ No 8 Le i a <br /> of l , p� � Total kngthlske \ <br /> FILTER SED C3 Das =o nArers::.` Wali ndaircn Property Uns <br /> SEEPAGE PITS I i Oepth 5rzt � _ Numbat <br /> SUMPS Vi Ciatartta to neatest- Watt FOuf1datieel Pmperty Lhe'— --- <br /> DISPOSAL PONDS.; 0 <br /> I 1lerabv certify,teat I have prepared Otis app=ieatipn and that tat rroric w+7t be dans in accordance with San JoaQuIn county ordlnancos, sista tarts, and <br /> rules and regulations of the Swot Joaquin Caszty' <br /> Home!ownet er licensed agent's sL r tune c*nif4m tf%o fottowir4;:"I aartity Thar in the Worrhante of trA work+Ter Which tlelt,permit is issued. I shall,tot <br /> ernplor any person In such manner as to Decor"a+ajeet to wtwktnsds compoemefiort larva of Carfornia."Contractors furling or sub-contracting aigRBtufe <br /> r edMi s the fol4N ng."I caNfy that in the p6rlorrtlance of ilia work far Which tN$permit is.issuae,i shall employ Pomonf subject to worlentiar►s cornpsnsa- <br /> lion laws of CaGfbfttla:' <br /> The applicant ff tali sat e=repaired irrapsctkwu.Comptsta ditwing on myerse ode. <br /> Signed rte+ en for rlo� e� Date' <br /> • m �.�^... — <br /> OR DEPAR AENT USE GAILY �y <br /> A0p;czWfk Acce¢tiC W Aau "� Ares <br /> Pit or Grout leupeeticn by Data_.,,.� .�Ansi Mspeollon 1 Date.,.,.._; <br /> Addtlarwl Camenehw <br /> Applicsat - Ret4ra &U acg" Lo: SGA.7aattain Cot=ty NU—rt Healt'.h <br /> i Ses�Sees. �vlreaonasaZ Health p+er�tt:J3errlees <br /> 16M �L Ulelt-= Agra., P 0 Sox ZW9 2 Stoctt od s CA 55201 <br /> FEE, AMOUNT:)UE UNT REMITTED a RECEIVED BY Qa=E FtRMrf'nb, <br />