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APPLICATION Fkdt Pl.jiU I I
<br /> :;AN JQAQUIN COUNTY PUBLIC 1f1-:A1.111 ShNVjCh:,
<br /> R-4VIRONMEJiTAL IMA1,111
<br /> P Cr BOX 2009, STOCKTON, CA 95201
<br /> (209) 468-3417
<br /> 11 TL f:xP1gr%;.q 1 Y6AA_fAQX_PA1'j_Lj=
<br /> (Complete in Trip11 .-Ate)
<br /> Appliretim is "rely rot.,., -4-In Courty for a porzit CC-v-6- 4"! Cr lf`,6*A,. 1`�P ro
<br /> VI!.1 San Joaq-jin county oralnerce 4
<br /> .foe.quis County pu!qj, and "t P-6 arl Roor,lations, of Ran
<br /> Joa Add'...
<br /> C- A -4P
<br /> A
<br /> r
<br /> TYPE OF WILL,PUMP
<br /> L T.L F%(P,ALF*.-t'.' Servtc* W.11 C
<br /> SYSTEM 03EPA.0 W"All,
<br /> 17
<br /> DISTANCE TO NEAREST SfP-!C TA-,V SEWER Ll%� S ___ :'tP:SAL FLD Pit•
<br /> )o LNE
<br /> F0,*NCA1;0N AGRICULTURE WELL 01"(0 WELL PI'S S._MPS
<br /> INTENDED USE TYPE-I" ,%FL, PQO8i EM AREA CONSTPUCT,(11, SP;C.11CA'IONS
<br /> 004 0.8 go We*11 We-'Clos.ng
<br /> Ll Doonset-c/Fit-valo G,t.v ,'a,- Trp of Cos,-;
<br /> M P,Ibl-t off- ._1 Deltachlliln of G'o.f G,",_
<br /> 0 lff.ljol," At)l,,. . fl.j, ralle'n $,,lace Se'l
<br /> 0006-1 Wo,b Done T,lA 04 r S'sle Ao'lo Done
<br /> Wool Destruction O wof,, %0dalfIl5 Platiorial 6 :v;--
<br /> F121*r Material 4 ropth
<br /> ,/--YYPJ OF SfPTIC WURIK NI 1,i'A!tAI_j1;%,1N RiPAIRIADDITION Dt!,_1l4UL_.31. -%O-"i)f.c ovsfs"vqlm.flfd-I ol'b6c silwort is
<br /> IM11141181-On WAII se" R oonce .. (.0-me'C'no -Othw
<br /> Numbef of Irving un,!/ __1
<br /> _ N---!
<br /> Character Of 0011 to a depth of I tool
<br /> SEPTIC TANK 0 T,ps, Wvs,table degith
<br /> cat.. IV 2
<br /> No cornoon"fentl f C-)
<br /> PKG, TREATMENT PLT.Cl
<br /> k4eveod of lo,
<br /> I me
<br /> LEACHING LINE .e
<br /> FILTER SED 0-11sn's to -08,06t wiiilo
<br /> Fo.rwsf-om tine
<br /> 4 SEEPAGF.PITS I Clopth %
<br /> S-11
<br /> SUMPS LI U.slance lu nos'est Was Foundation
<br /> DISPOSAL PONDS 0 0 _ fliviso"Lone
<br /> I hapoty cgrl,tv lh#t I have p,tI,&,qd lh I at 'P'&I IN9 v%,011h w-0 be Mine m a.L,; jlf�.-s w.lhSon joeown to.�fv ,j
<br /> foes and regulat-ons of it's ss,, C- t 0 01. 3410 lows, and
<br /> Home owner of I-conlad agent a%,Q' o.
<br /> 0-olov any person-such"Ams, con'tv to'&'in the P" -It 0 Or'"s VVQ'h for 0,"-t-1-11 call 1-1 ss-jod. I shall not
<br /> lion to the lovow,mg "I certify jra t'# 10 w0lh�dft'%Cimosti"l-on a.i -s - Contractor S-'g 01 vvt Wnt,101mg ligmatuff
<br /> lion lows of California LtC_j-# rce Of the oork to, IN-&pe" B"lla arw OR400Y 0"sicnif s,D,*CI to-ohmem a corrhoeft".
<br /> The a ant 14 or Olroels ljllwlng'Y'
<br /> I ��O��
<br /> Signed
<br /> 10(,DEPARTIkAIENT u51 ONLY
<br /> Application Acceoled bv .1_
<br /> Pit or Grout Inspect on by
<br /> F bv
<br /> fid-10 - Dole
<br /> Add lbnal Comments
<br /> Applicant p9turn all c.,pj^,, HMTN 32FIVICES
<br /> tII,A.,TIl UIVISION
<br /> skh j0AWLIN. J, 0 BUX 2009, S71- K: 1, CA 95201
<br /> -CASH of" DATE 0
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