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1.7Cf�'• ' ± tut JOA4111H COMM PUHLIC HEALMI SERVICES <br /> 1414 <br /> Ls1MVIRONVENTAL 11HAI:rH 1JIVIHON <br /> 045 N SAN JOAQUIN, PHONii (203)468-5424 � <br /> 1` �g P 0 BOX 3608, STOCKTON, CA 98391 <br /> Vi� n,7 P� RERYIT tSPIRIIS 1 Y ' - -- - - S59llEI3 <br /> vp ,f" � F r tl'�' (rc1nF71r Ee In Triplicate) <br /> 4pluaifon is p r.1y aeei to Bur Jcrquia to%Aou foe a %trait w ccCatrurt antler lnela17 Lbs wurl Lareln dt{trlttd. Ins{ <br /> al"llcollm 14 wc+ 0 towienea vtth Ban Joaquin CaatY oudim ca RP. 514 ecd 1869 aui 1:11. Auigl atd Reawat7ple ref Seo <br /> Jc q:LLu Ca ty PP.Wle 11"Ith Ae"Iceaf•r+ r <br /> Job Ad117e l rf r/ 5 fj���� - } Or- E 'L Fit 87 ulacrp`tor _ ., 1 <br /> Owntr.Nlm/e f�I ,, l f_f, 1" Aeo-.a .F/0 +!}/� �'� t'P'w <br /> CW4atia• e1 ' 11`}lll Jf� /4' .S AuO'el. <br /> No. <br /> Lf .'dPhent -'}'!-`7[l� 11 <br /> TYPE OF YAMPUFAP: NEW WELL " WEL4 REPLACEMENT xfJESTAUCTIOYJ Cl Out, at Rarvlca Ye11 _ <br /> PUMP WSTALLATI SYSTIEM REI Ifo Li OTHER ❑ NDMLartng Pell It <br /> DISTANCE TO HUREST� SEPTIC TANK _ST_L $EWEA LINES _ 'tLf DISPOSAL FLD. -'" PACO. LINY i' -0 , <br /> FOUNDATION 34"t�t AGRICULTURE WltU LL 1�.OTHER WELL�-= hYSf3UTfPS FiY-i I- <br /> INYENOED USE TYPE OF WALL PAOBLEMAREA CONSTRUC1iQfa SPECIFICAncwis , <br /> it utaueRNl ❑Olwn ganorn ❑ IN4nlere Di1. of Vhl E.cwng5lj..,- � Dil. al wNl Cm" �L... <br /> }e(py., Pr«alt L G+w.l P.c{ Cl Tracy TYPe or CttrnB__ Sp6nPeallons .. _ e ` <br /> 1'I Punit 11 Olt." f1 Dtltle O/Ptl1 al Gloul 56x1 - �� TYPE 4'vgu I l <br /> I I lrrtyliva __ API/g. p.c111, 11 Etslalq SWr Sawa Inv4sm 6Y w _ <br /> r le 1 ? P. �,}' Snta Www Uane � <br /> It9pwr Wele Dent �1 FYPa 61 Pump '2•� l�IP � f <br /> {W W Oetvuman Cl We7 p1Ar.41 �►LwY 17tttrUS E Depah <br /> Dpplh b 7711/r slatartel A Depth _ <br /> TYPE Of SEPTIC WORA: NEW INSTALtAlION I I REPAIRIADDITION I I LIESTR ttON I I INP"F"r W skim Nn lwl Al pnPIK SAWN 4 �. <br /> ��_— awMP4�.1lhm 700 feel l <br /> a1g'Jn1LM w11f tarot. Petitlenu CalrO..tre41_ 1}Ihp <br /> MMM a a .E;4wim _ N.rbel al md,oco'rt. <br /> ChNa4IM W 46414/44PIh Of 3 T/N: W{lW IIUe 4110h <br /> SEPTIC TANK 6 Tywalltg r pA.iLY Nu. Cuet'*Aa AuIA <br /> PIL& TREATMENT PLT.0 . u/lhng al C.Woul <br /> pi lYce la'..neat: Will fW lion PP*4ff, Lm <br /> LEACHING LINE 0 No, E t4nga,gl 7no Taul mlpmfNee— <br /> FILTER RED 0 Pmv w n/anl Wall FawCrbn ___ Pramny Line__.._. <br /> SEEPAGE PITS I 1 D.p.h fi+A _ —_ .__. Tlumual <br /> SUMPS Ll Dwit wmreu; Well Fown4van Prpptrly Lin/ <br /> DISPOSAL PONDS L9 _ <br /> t n.ribv etnilY drw 1 hew pro wad INN Ipplca 4r,lnd 1ha1 the Worl Wll UP bans M/tcnldunt/wnh $an Jnngn.a ccun.(mllr14n;0s. 91410 Iwt. and <br /> eual and eWolol1 6r I"SO)Joegan CoyalY <br /> 7414'4;I a 4r v IKennld 4genfp pawilm mlm,lh/larlvwngg "I trlity Thal m the P•rlonn anal d Ih/wuik O9 wlrtli kri{M..[.*. d, I.hal nur <br /> /mPUY MY I....in au1i1 mYnMr"IS lleaeav 9u6lttl m xaX765efi 1 aolnptn"llofl NW I of C4I44104.' {aaalet[m L hillM1p 41*J Ga &/Fang tiphhll/e <br /> 9/'1114{WfaMbwi/Q"TKe1PTy lhN htrM pWNemlilGe PF the wP141nr whKh lNt l/V ma�1.W/r1.lWe.rNgY E•t1/afte R✓••{/sa lg+MlRmer:e SPmPtlaFt <br /> tan YM ul C111arfda." <br /> Tn;APPtataL m76"lar AG 07 N rpFt"Ai, Compllu 4D&MrrB an 16wlla Ida. 1 <br /> Ygr�a `-_ •e! Lf�JJ '///,;,c Dow <br /> t,= Fytp CWAAT0AfNT US.-ONLY <br /> 1PPIK.ben A-"Wort M Y - foal/ Are1 <br /> RL or Gwut InwKilon LY Da;I.1L'„_ tntl Ln{p9cdon EM— LAJ-`�-�' ', Dug <br /> Adah"I C4mrtrnle. --- <br /> APpLIcOat - Ndwrn a1L SOPIas [ 801 Jaequtn <br /> teCl oth <br /> "AItII remxU ee* <br /> 44$ m H.. W 0 nu3-00. SIX n,cum <br /> _ <br /> Ga Y6etl1 <br /> FEE AMMI PPI AMaLWT nLVlil tO cxsh Ct:71Vlp AY DAT; PEPMIr ND S <br /> NFO ff� <br />