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<br /> APPLICAT1UN FOR EIE11MIT
<br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES a
<br /> ENVIRONMENTAL UALTH [)!VISION
<br /> P 0 BOX 2009, STOCKTON, CA 95201
<br /> (209) 468-3447
<br /> khMIT KXPIRSS 1 YRAR 1FRUY DATE 1SSIIlIn
<br /> (Complete in Triplicate)
<br /> A,Plicatietl is t.ereby sad/ to San loapulo County for a point to co"utruct ander install the vert Aerate doserlood• !lila
<br /> appllcatioo Is 5^49 in cmMli►rce vit4 San Joaquin County Crdltianco No. 119 and 1568 and the Pules aM PelaLtle" of Elva
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<br /> Joaquin County public Health Services. a.
<br /> /Job Addeo" � �-----__ C Ir�-ie���Lot SIN/A:►aada
<br /> f .Nems .yy Andres, �4-1-7�v� �aMo
<br /> tCCc�trulaa L'•E�l�Lil..J.AS.�.�'.a•rss �lvV_��Q___ � rf. ho E.Q.p1fe�r"t,Ass
<br /> TrPE OF WELL,PU4tr NEW HELI ", y\y Ell REP.ACt%LINT r DESTRUCTION Dot Of rvico 7.44
<br /> PLUMP INSTALLATICN SvS,FM R[PAA OTN[II I4o611116M lb dell R d
<br /> DISTANCE TC NEAREST SEPTIC TANK _ SEV:(R L`%yS _ DISPCSAk OLD POOP LINE
<br /> FOUNDATION ,-�AGRICULTU 1\ELL OTN[R HILL hTfr3UMIs
<br /> 'NTEND'D USE TV►E OF WELL PR0St140AR[A CONSTRUCTION SPECtf'CA"ONS -�
<br /> Indust tr L1 Oven bottom Manlocs — Ota of W"E.u.alon— ----�. CM of WM coo"
<br /> U Opmam,iPn,It/ U G,ovw Pock i Twit T1see at CIwQ _ ___ Slac acarota
<br /> ►uWet 1 Olnet peIII D1ltn nl G•nvI %66-
<br /> T.94 of Wwtl
<br /> G Itt4jf ton Ap,ras Deal% L. Motel. Sr.'race SNI le,sIP•ad Iw t
<br /> Row Nal Don. �2 Ttpa of►vmp N► � StH/WI16 Dona
<br /> Wev GNltuctton C Wel Dtlentow oeallna Ibtterial 6 111111
<br /> Dowel, — —�--_- ►1115^ Ibtarial a [aµ11
<br /> .,-I YPE OF SEPTIC WUNft NEW INSt AL LA I'UN� NIrAIN AOUt T'UN - UI StRut.IIUNtio septet%,ssem 9alAutRea ed0"IK NwM►la r,\
<br /> haNW w.tM 700 Faa1 1 J 3
<br /> IMI0614A uIIN NM A leltc/_✓ Comt�le•ral._ Ott>wt_._.-___, 1
<br /> NwnM•of►r1ng v-.16T N,-be.of bap" ' / -4 i
<br /> CtV,atot of 6011 to 1 depth of 3 hat �•' � 5�1�:_.___ _ - _ __ -wa1M 1aWa�Mn � �. _
<br /> ` SEPTIC TANK C, T,y,e'llltb� r+.� f._.\ ` _ 1 cooac•ty No coleveettem ` t=
<br /> PKO TREATM[NT PtT '. -1 fr4p,odof u t
<br /> E�sunee tc.nes rel Nee _`�_. FowON on �a P+ot.ytliris n� «
<br /> LEACt.ING LINE Lti Nc S loNt.,e, :rrys _._.,� _ total zeroth.We �.
<br /> FILTER IIED f ' D-910I to nM'Nt WM 00-Nds"on _.�,� P,*Wv Little
<br /> SEEPAGE PITS i Ueplh -_ 1 -S»
<br /> SUMP'S L.ovwx*to nN'Nt Waw 1 Q Op woalin rdIs'npatl�lM
<br /> CiSPOSAI PONDS !1
<br /> 1 hpebr mi-ty Ins'I hsvo P'epa'sa t'.1 at•l"+Nti.n Ind test In/Awl, " !:e d,I`a.n
<br /> tvtes and teovlll Ons o' Ms Son beau- Cc_t. a 1u'linea A•In San Joepwn tett sh MONtKN.NIM 11eea,am t
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<br /> Nan/ow",o'I•ConNd 090-1 s 4yn/I„•e tort lot Int to.oA"S I cIn t, nt me wa•e to,weKh tTt1 Partnrl r raWael.I Ntaa Res
<br /> .wolov Int perlpn IN suit+tnsnne•Is to Pet or•o s,Dn,l I; Ao•.^r s 11•^VnNI vt' eAI:I f Ii,twn.6 CentrK la I Mr.b a atA toAMatery atrMwa
<br /> tMdtal IM talOA•n0 I CM'ly Ih� fila pa.t CtlnanCa 0f'nI Au••to wntn!�•M•^t yIa..eO ,atvr,otnPtor OatNN a.tAtlfa M Mrs elle•plsraaB•
<br /> I-on taws of Co"a
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<br /> The a Int N eo w ompela 1 0"On the.so$40 �/7
<br /> 1t Sytvd K. __. ----- T as S Dom.
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<br /> ' FOD[PARTAIENT USE ONIr
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<br /> ApvI",-en AccaplM It'll �.�_►L�.�,. ...._±.i
<br /> ►n a IStow Inapecnon by sral tnape;tgn by
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<br /> At1MtoM� Comments _ _
<br /> Applicant - Poturn all copies ta: SAV JCAQLIN cY"111` PVbLIC NSALTN SnIlICIS
<br /> EA11NL*Nl.M1AL NIALTH UIVISI(A PWIIT/att1VICP3
<br /> 445 N SAM J"AQU1M• Y U II1.t 70011t, 5-%x-k IVAN. CA 95301
<br /> r tt[T- MOI-N' Dl.f t,• t y• t.ly••ID ��T R(:f"I D t� .fD ar �TI ryaWl MO
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