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APPIACAIAON 01lt Phl'16111'
<br /> .I" II)AQU 1 N ('0UNTY 1111141.1 r' II)-:A1,1'11 :iRiiV 1('1:'
<br /> I-:NV l IMUNW-KNTAI. 111:A1,'1'll I)1 V I:i ION
<br /> 11'01 N ::AN JOAQUIN, 11HONI: C'010468-:14::11
<br /> 11 tl 11OX OOt,), :iTOCKT0 ,,11, ('A 957.01
<br /> It IIrn1)1ntF1 In ( f'll/ilr�nlrf)
<br /> Aptrllrstlr.n to hereby rvA• I,. clan J, q,iln cm,niy fur a permit l,- rnnal r-1 an-1-r tnat.all the v k her v I-orr Itort Thla
<br /> app IIcot Lvel la arch In , -%,I I&. - It rA,, JLaqulu I my - ntlnslna a '•"Y 601-1 legs' eM the Peek-. -10 ►•41116tle uF nae
<br /> Joe4uln County Nblic Health Services.
<br /> 3Jcb Add,*" — �VM lJ�._�7 ✓_�....-_ __ sly Sfrr�r r�, L . ir. •..+,• ------. —_---
<br /> Ownat's Noma �/_►yL- _.!/__'L CM,,,0 j7 7`_ At ossss 1/17/17 ���M f7f 7`(� e._ rt • fl�r �G/�I_lt .
<br /> I s„Belle '/••�Il�P/ /'i I�� a IP I `�P �l/C,//'I r til
<br /> s 111 W 111 (l F t11W W111 � W�II AO Al fl,lr, UI MTAIII rlilrl +, „f 16r.1.o dell n
<br /> it 0111,,1 volt
<br /> PUMP 00.1A(IAIION Ii IWIMflff'A1f1 ; tlnt)n II
<br /> //��. ` «IIP uNfU
<br /> DIITANCE TO NEAREAT "IlPf” IAN- '� t/ /t fIIWtA IINIS _ 11i1.Pr)kAt ftf) ]Q
<br /> _�- ---_---- FOUNL,AiION . AGRICULTURE WELL — OttIER WELL_____
<br /> INTENDED USE TYPE OF WELLPROBLEM AREA CONSTRUCTION SPFCIFICATIIIS
<br /> (1 nd•strel �U/pMn Bottom 5 Manteca D-o of Well E■uvatrop Ota of W s C»
<br /> Dornestic/Private YCrravet pact C] Tracy Type of Casng t✓ �_�_ Spec f cstrons
<br /> I'I Public 171 DOW (I Delta Depth of G•o.,l $•+t
<br /> _ .__. 16__.. lrpe d Groin Polly.M r .Q
<br /> I I irugstg �f-i'n Ap,lroa. Depth I I Enlun Surface Seal installed M Q4tlf.11'
<br /> Repair Work Done 0 Type of Pump H P. _ State Wort, Done
<br /> Well Destruction O Well D.emelor --.-- Sealing Haterlwl 1 Depth
<br /> Depth Filler Material a Depth
<br /> TYPE OF SEPTIC WORK NI.W INSTALLATION I I REPAIR/ADDITION I t DESTnuCTION 1 1 INo septic system po'—fled.1 public sower of
<br /> ivarllbN wwrlMn 2C.)Iwt.l
<br /> Installation will verve: Residence_ Commertyl—_ Other 1 J
<br /> Number,of Nv"units Number of bedrooms
<br /> Character of loll to a depth of 3 fact: Water table depth
<br /> SEPTIC TANK O Type/Mfg Capacity No.Comportments E�-
<br /> PKG. TREATMENT PLT.O Method of Dreposal Vr
<br /> Distance to nearest: Well Foundation Property Lune_
<br /> LEACHING LINE Cl No. I Length of lines Total length/sae
<br /> FILTER SED O Distance to nearest: Well Foundation Property line
<br /> SEEPAGE PITS I I IMpth .-_. . Sue
<br /> SUMPS LI Distance to messiest: Wen Foundation Property Lina
<br /> DISPOSAL PONDS 0—
<br /> I hereby certify that I have peopaled this apol"tion and that the work wM be done in accordance with San Joaquin cl my urdnances.state Wit, one
<br /> rules and regulations of the Son Jotiown Co lnty
<br /> Horth owner or licensed.gent's apnaiwe rertdw the following: "I tenth/that M the parrormanc•Of the,work for whwh this perms-a uaued,1 sine"not
<br /> employ any pweon In such rnanner as to hacome subfect to workman's cothgensallon Laws of Coldortnla"Contractor'a hmng Or euh-conttectirq siometwe
<br /> conifkMl the follovAN:"I certify that m the performance of the voile to which this permit to issued.1"N employ persons subtest to wa►men's tompen".
<br /> Hot,lows of Camornll."
<br /> The applicant c&N f W roqu Inspections. Complete drawing on fr,*A aide.. p
<br /> S' nod X /'c -�.��� Title:
<br /> FOR DEPARTMENT USE ONLY QQ
<br /> A L(
<br /> D
<br /> Applkatfon Accepted by � ��--�/�s'y/� Do,. - A._
<br /> Ph Grout InspectionD �'f- �'"`'� ,l� Dal✓,� F1nal Inspection Oats,
<br /> Additional Comments 4&_X-eZ C�l��•`�J�f�y�'� ------ _ -------
<br /> Applicant - Hoturn all coptenn to; San Joaquin County Public Health ?rrvicee
<br /> Sovlroewental Health Peraoit/Serwtree
<br /> 445 N an JoaQuin, P O Bon 4000, Stkn, CA 96701
<br /> IFEE
<br /> NFO AMOVNT Out AMOUNT Itemor Eo CASH CK "ICIA110IV DATE eEAMIT NO.
<br /> r1 7
<br /> . Itr,i.N IA[V ,,.ti ,� f� 9. Com-- I,
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