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<br /> i • APPLICATION •
<br /> ISAA JOAQUIN COUNTY PUBLIC 0;ALT11 SB9VIdZ5
<br /> sxvlltoNvzNTAL NPALTH DIVIOXON 0
<br /> 449 N SAN JOAQUIN PROMS 1(209k68-3490
<br /> APR
<br /> P 0 box 20096 kT CIKTON, CA 98291
<br /> PERMI�tIBg" _Y1A A XBQK DATE. SSU
<br /> ((COMPI9te $tt' Tri➢licate)
<br /> APP7Aeaetoe As krrAAy N'44'" an JOYAvin County for a periost to eonotruet and/or snoasll t1+e 'verji lrsteld ACAsrib!d• Thi,
<br /> sp1114e116ak Ed Glade to AoaPl,la ee vith 01%9 JHeufs 00..,.17 erdfosnoe We. $1,9 and 186) aM the Ryle1 tied of Ban
<br /> jmToia County NVIIle 11/aloes %rvrvi`cto..
<br /> job Address ���,�(( �rV�..�c.-�r �.[ .C"�f P,-"• V_ City � .4.v Wt M1 se/AerenRn -.-.;...,_..�.I
<br /> Ownr'e Nema'..L�.�t"" 779 f �t Add,ev a�.. ..,t.v��'.~,..lA,'1C�1 �-�'.- phone �..._._,___„--i
<br /> Viso 1( fa 1 -:w f• fir, n: �zv�' a CA `f IJ/ _ • e5 114 -
<br /> n 3i33 r- �a �Ap` daJ 9
<br /> .�Adafets 14A-t I-Y.
<br /> a __ LIErn1r Na. 'Phone � Q;._r}.6 1
<br /> Pit E Of-WEVU UMP: NEwwE4l f7 WILL REPLACEMENT f.1 Df6TRU . ION S_ o//uk er`�erv•q'�i"kio,{t[I -
<br /> ►UMP IN TA1,LATION O SYSTCM REPAIR Q OTHER W\ ^itK'FInB Vgll
<br /> DISTANCE TO..NEAREST; IdEIeTIC ANX -r-- SEWER LINES _-•__„- DISPOSAL PLD.—_ PROP. LINE
<br /> OOUNOA, ION AGRICULTURE WELL OTHER.V44t PITSIGOMPO ._
<br /> iNTENDEO $I Ty t WELL PROBLEM ARIA CONSTRVCTION SPECIFICATIONS
<br /> V Inovrldd (P Open ddtfom Cl Manteca Me, of won E.rtyptlon — 013. el we& Citing - ,-- - -
<br /> rl Oynsehcf Pdvud L1 Grovel)Peck O Tracy Type of Gar+^a-- SpeclprlYsrls
<br /> I'l Pnnnt ri Olnat n Orgill 15#01h of Greut Sed Type of Group,..` ~moi
<br /> I 1 INlphlon —AOnf{os. Dedlh I 1 Eastern SuMea Seo,Inpalled by
<br /> Rlpelf work Done U type W Pfymp M.►. Staid work Oone
<br /> Yha DHt/vCtiOA b Won 011*16H 4ealinE Material A Depth
<br /> • � . Olpth • : Ehler >+!Fvrlal � b.Pelt
<br /> yP 1 RKI NEW IN TALlAT10N I 1 R PAIR/AOOI ION I I DERTR CTION I 1 � �4At5(Mlleti� !�Y I /'IN r +ear I -'
<br /> In1lNgtldn VON %$,vef 111elld0iRea r,,,- Cemrhottlal — Other
<br /> Number d lying units: -._ Number of bddrooml
<br /> Chowtsr of ION to 1 dep)Iig of I list:
<br /> SEPTIC TANK, Q ' Type/fdF/ Capacity, No. COmaf+- ..._.r„
<br /> PKG, TREATMENT RLL O APR Mzslpa9�t Qldporp _
<br /> Dlalanfs to neersdt: wen Founda0on Profrorty L d L
<br /> LEACHING LIN/ 0 No. 1 Length of ones ��Q,E� ICES ,_�,,ti,�,•_.,,._....,.�.
<br /> 91099 SFO L1 DitlanFe 10 nearest, wee Founeation -PPP F I
<br /> SEEPAQI Pill I I OOPM ,,,, —Sire �, _ Number
<br /> SUMPS LT DUnnca to nBBNec wen Foundation RropOfly tine
<br /> 016POfi.Al POf�4 O }T'
<br /> I Mreby canify IMt 1 have pNPbed+1,,/•►ponce,Ien end thel tote war% wee be done In accordance with San Jaagvin 9ovnry pdi"PIC^I. 11919 Iew9, end
<br /> folaa and tegvlubm of the ban lupin County
<br /> Home awls of niganaC set is alp lure eerli6et the fdlovArle: "t eenily that In the performance el the work lot wrtlen lhls perinll Is 173,14, 100 net
<br /> d TOloy any.pdteon In such runner ori to becon+e eubpcl to woltmeKe C01*OAnsIPOn I”of Cllifornle."Conllaeloel hiring or suo.ConVeaing 919hiiv1l
<br /> Ed111H11 the Following; "I C$Nfy that I�the peffetminoe of the work for whith this permit ie Issued, I INTI kq,ploy person/ IV$;9ef ip NorkR+1^'s cornpontt.
<br /> 117h Ilya of CdlllofRll,r' �ie/i .
<br /> Us applicant mutt 40A for c` requl, Intpepdons. Complete dtlglnl pn rtyatla tilos. /L
<br /> Signed X,.. Title; [ Dols;
<br /> FOR DEPARTMENT USE ONLY
<br /> f
<br /> Apprrcaven Aceapred by -r.-- -....... DsN Area
<br /> rn or Grout Inlpseden by Dais fire, Imispection b�y�,, alto ,-
<br /> Addnlond Commsnw �7�rr:_J(_�` j k -
<br /> tY Applieant - Return all conics tog Ben lo►quis County pubis• 80611,1, 8ervieau
<br /> RnolrOngevatai Health Pomit/Borvloea ca
<br /> 445 N Aar, Joaquin, P O Boa 0079, Bike,.EA "?fel I S�
<br /> NF AMQNT out AMOUNT REMITTED WHPECE1vE0 By - CATE PEAtAR'ND. �f
<br /> APP -29 -92 WED 7 : 36 916 638 7276 P . 03
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