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07.'2911996 11:32 FROPl 70 12094690138 P.02 <br /> APPLICAT10N <br /> r... ..0 <br /> SAN JOAQUIN COUNTY PUBUCBEALTH SERVICES <br /> ENVIRONMENTAL HEALTH 1X VISION <br /> 445 N SAN JOAQUIN.PHONE(289}46=4W <br /> P 0 BOX 385,STOCiGTON,CA 95201-0398 <br /> P�aaYT 1�I 7�5 1, YRIA$�F�Oi[ DATE ISSITiiD <br /> (Complete in Triplicate) <br /> Applefdoo IF badq cattle b Sm JOINAOR Conary Foy a Pec'u"at abpNtUct aadlar install the wane heysia dcur(bed.Tisk pppGyatMrl is made in mmpliauu etyb Sen <br /> 11,1010ta Comtq Devalepmeal Tile Seedw P.1110.3 and koczeoa 0-1115.3 and the Rules wd Regu(afi=of San Jowia Cautny PabliC Neallb 5gaices. <br /> Job♦aeras, 14S S STITTBR ST. City STOCKTON L. t Size/Aorea[a <br /> SAl1 .7oAquiN wrNTY <br /> O.caes Nom CAPITAL PR Ate" 222 E. HEBBR AVE, #678-STOgR,�� Phone <br /> P.U. BOX 336 <br /> CanaaaprWOODWARD DRILLING Address Rid VISTA, CA 94571 Licenae,NO. 581638 Phone70 -374-4300 <br /> TYPE OrWELVPUMP_ NEW WELL ❑ WELL REPLACEMENT n DESTRUCTION U Out <br /> of <br /> PUMP INSTALLATION C, SYSTEM REPAIR_❑ OTHER C rrmltaftle Mau :J <br /> DISTANCE TO NEAREST: SEPTIC TANK NA SEWER LINES 50 -DISPOSAL FLU. PROF.LINE 52 <br /> FOUNDATION 60 AGRICULTURE WELL NA . OTHER WELL 50 PITSISUMPS ffiA <br /> INTENDED USP - TYPE OF WELL PROSLEMAREA CONSTRUCTION SPECIFICATIONS i <br /> n rneaarr 0 Open 94 am C Mantra Da• w Vyd1 Earsvadan 'r Oa, of Wad CaauO ; <br /> 0 Dommkipyiame M Oravr Pads CJ Trac, Type of Ca"_PVCspadlrutlom JCH 40 <br /> ('4 ❑odw m LV q� (3 Dema Opth of Grourt Soar 53' <br /> Type of Gww Cffi4$9T�BElvr <br /> I 1 fMOHITOA,TRC_o_rAppraa. aww I 1 Eas».r. S-4boa sra(Imola by Co U&CTOR <br /> Ramp want Done L3 Type of Faw H-P, Sum wofk Dana_ <br /> Wall OaaotrCbM 13 Wd OiatTlAv 8odaini llaterial a Depth <br /> Depth PL11er NatarlaL i Peptb i <br /> TYPE OF SEPTIC WORK: NEW rNSTALLATION r 1 REPAIA/A0017ION t I OES RUC N 1 I (No septic aysrem pamattea a puhbrd er.Wr.si <br /> evallabtl volh n 210&w.1 <br /> IfltdMfailatt vvN Serve: Heaidertta T,..,. Comrt+maal= other - <br /> Ntlrlbd 01 iwtp u ' -- NuetWr of bodmoma ; <br /> Cf.are"of tea to a dopa o13 lift- —WSW tabla daptfi.-. <br /> 501M TANK [] Typa Ml@ Cape0lfl No. Canwat mann I <br /> PK6-TREATMENT PLT.O mathod of Oispong <br /> Dlsrarex to nearest: Wal Fe.ndatitan Prop"Lina <br /> 1 <br /> LgAGHIN4$Alai Cl No-k Leath of Iataa ... Total largthyaieta <br /> , <br /> FILTER QLD Ct Distanw w. I: Wert Fp.+noarim P"PMty 43M <br /> i <br /> SEfPAOE FITS is Own SA" - - Nurr.bar <br /> SUMPS L( Distance 19 p9wast: Wall Fpudetian Property Leen <br /> DISPOSAL PONOS O <br /> I Iw obV cw v*y That I kava prfpstad 04 eodicwio�and that qts.4 vel ba dope u,accords wd with San Juagun ewnty w&wmm 49M ta/w. and <br /> raMa and gyrdaValla of III*San Jaw fits CmutW - <br /> Harm owns ow aearisad aarac'a aipr+le+n cartiFiaa the falbwirg: "f tanriFY that.n d a prrfarmonca of rho wars f«which tpu pepnit o AaJrd. 1 at+a9 rwr <br /> elapid,any poraan M such nerpwr as to baeap.a sub*,to wmkmaa'a egnpapaafien Wwa of Coglo rra.•'Cgntft *bw it^w v_4ww4r&C*g talrtaturd <br /> e■etxr the(aapwlrtp:-T tarrph that in tIH paAdelyMnee of Ry work lot which tf"pamal is uu uad, 1 OWN aprploy persona eubHet to waAntarya aomlaw". <br /> via"Tarns of CaetopW:' <br /> riw sp(*aan rrwvat-c�a0 barer q requrad' trona: olo drewirg o t rw.nao aide. <br /> SNP"X�-�C Tisk: Ip1l S/ +y'r QMr: -a <br /> rOR DEPARTMENT USE ONLY <br /> Applaa"t AecaotM bv� <br /> PN or GWA mopwom by Oats Final frapocaan by Oster _ <br /> ArJIdIOaAf'CanrnaMa: ��IiS �� p�-✓tntfi �" i�9�- fr•5�-C11y�'- <br /> f. appllaept - Retaee aLL coYica to: Ssai®gaiu Ca®ty Public llcana Senim <br /> ESviroomimui Health PC=iVSwvkn <br /> 445 N.ffiw 3aeguio,P.O.Ilm M.IlloeWpr.CA 95MH413N <br /> 3 w!O ANOUM DVa AeaDVN7R[NfTTEO CAH Rtno BY pwTE eLRwU44f <br /> A <br /> "( <br /> . stm;,tay.traa, $`1. � �'q 6 5�a _ WLQcu,P TZ4-`16 °O ra ay � <br />