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97/24/1996 11:33 FROM TO 12094640138 P.03 <br /> APPLICATION <br /> SAN JOA"COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTALH ALTHDIVISION <br /> 445 N SAN JOAQUIN.PHONE(20"-4f 16 <br /> P O BOX 358,STOCKTON,CA 95MI-0388 <br /> t!$OI1 DA�� ISSIIBII <br /> (complete la TrfPMa!te) <br /> ApphutwIt in heaady atoft w Sot]o*rdn Wuaty Tw a pmmlt In,modwd U&M instill the watk baein desailtw4 This fppli==is merle IA campus=with San <br /> Imgv n C tmty DmjVwml Tice SaWm 9.11103 end Sectitm 0.1;133 aad the Rules and Itegulativ of Sen]onuil Cwwty Public Health Serpins. <br /> jb Adtlrasr 145 SUTaTEER INS <br /> T. C" STQApN L, Slat/Acreage <br /> ei,,t,r.,1w,,a CAPITAL BRO.IECTS Apd,e$ 222E WEbEit AYE fns STOCK _ <br /> �IPiwne �-1168�218Q_ <br /> Axn DRTTjaj P.U. 6070 . V <br /> Cwarckwjj2pW <br /> & Address ginyTCTA ,�,gly57t uteme no_`x$1639 Pkdnr /07-174-6:0 <br /> TYPE OF WEI.t/PUMP! NEW WELL E1 WELL REPLACEMENT 0 OISTRUCTION O Ons ed 8!t'riNt Y911 <br /> PUMP INSTALLATION O SYSTEM REPAIR ❑ OTHER O Noalvoraw Mai p <br /> DISTANCE TP NEAREST: SEPTIC TAW NIA SEWER LINES 15 <br /> - � DOBpOSAL FLP-, N A PROP. jIME dr_r...._ <br /> FOUNDATION 20 AdAlon7VRE WEL *41 <br /> L 4tt�_ OTHER WELL 1l ptTS/SUMPB jUAL <br /> INTENDED 6SE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> ..h Indtralrlat .❑OPdn I)eften, ❑MaetwaO4. of Wa1F EacaaaW 0.0.d Wd CasYq�a�//.� NIA <br /> (,t PPm,pa$M/PrAwta o awyo Peek - Q Traer TYpa d C.N�O-- Te/A BpadRfytlana_ akAY..,�.� <br /> �•� MeaOitox3ng.60 rm0r I'I Delta Depth d Grprt Seal --WA— TV"d�.,. <br /> Aplfak. OatNh. 1 I Eastam '$.,Asan San IrotaGud by CE1NTTteI'.TnR <br /> Rapdk Woo k Dom U rtV9 d Pump H.P. _ State Wwk Dou _ •—� <br /> Woo DwwArlm 10 Was ownew itaaltng Material A nwi;h <br /> so 1 I of�/ro1 l3 D:vin _ nhe <br /> uar material a D"th <br /> TYPE Of$ WORM, NEW INSTALLATION 1 1 REPAfR/ADDITION I I DESTIWCTION <br /> #rdil4N within 200 IM 1~d Pic www is <br /> htaiaaaatiRn"Mtd1Yd: RdaiOdnpd.._ GwnnmrcW-�- Ott" <br /> Nu„6«pf"WNW Numhw at bo*Oohu <br /> CAwaoew of dpi To a dgnh d$(&r, _ <br /> SEPTIC TAMKA roelM R CylaeOty,`. -- No.Cont�wNp9rrtq <br /> water � <br /> ..P".TfrATMENT PLT.Q method d <br /> DidteRCe nedrait: wellfowtde60n Pfloony Lind <br /> i EAgeFYG LINE Ll <br /> No,A Lanprh of Inw 715181 Ienythl se <br /> fp.TEtt BEO 7 Offitartce to rmw"t Wall Fo--ostmn MoptptY Otte <br /> 9610AGE PIT$ 11 DoomSUMPS . Eire NUIRgw . <br /> 1_7 OLtitoam tmwdN: Wap F9andahon Ronwty LOM <br /> DISPOSAL PONOS Ca <br /> I hwp oartIt, that O harp wawwW Ms BPPNGNIw and that tM work rr1 ba dorm in accordannd Wtth San J <br /> rttlu and fapgatgn.of tM San Jwauin rr9mq, CaBtAn County mdnsnsw,X"%*,L stat <br /> mpk <br /> otlar a Trotwad dQatR'd atBftattrn CYD1W,dmf - wale tw a.hiah h <br /> otbwinQ: 'y c.rtify d.st in Ma awt«nwlca pi dm <br /> &afPkM.a ' <br /> Y.adeMrr n arGr Ofmnlldf as m bweNndJtftyrtt t2..9rketaG'a is paffllll�e1r/,1 ffMa not <br /> Ca4ch thw len aWn P1.C4d fdma."(:OMraClOf i twvv ft�a-G"Vtva <br /> *n YafdMM o1 CafCpMl." f y ihR tl Rte pa18RRwtN d Ma wwk ler whidr dw pwmil u uet.red.t 1fMk dmplay pdNply aubjaat SO MOtktMdn'a pgnper". <br /> Tlm"PkMM VWW C40 far ds m9uitae:tap tkm.CwApfs on <br /> . ... ..._ •• nom: �/ i5i� / � J ,P-_ Dam: <br /> FOR 6EPAR7ATENT USF ONt��/I/�, <br /> APPaaksnAcppmdpy/ I,1 (y,'`t[J _ `✓W1 <br /> Pct w Groat kOp t ra in _ _ A <br /> pp .�._ Oa1n Final(rypactitn <br /> AdMWW <br /> APpiicaat - hetes "I COV149 tot Sminquib Cgmly PoNfc HnIth Srrvicer <br /> 8artblfth rl NaWth Pe®o/S*n%cft ' <br /> .40 N.ban Jwgoky P.O.Bea"k Stocateu,CA95Yu1,O3.W , <br /> t <br /> f <br /> AINOEJNT ORE' AMOUNT AVAMEv �A.sN RE[II: an In, OAT£c, PTNa1tYNO. : <br /> ���� �A p7 9 w3 t <br />