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SAN JOAQUIN COUNTY POALIC HEALTH SERVICES <br /> EN1r I RONUMAL HI'.ALTH DIVISION <br /> 445 N SAN JOAQUIN. PHONE (209)468-3420 ' <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> P IT IseI1I�R4 1 Y AFI YRC;i DATE ISM= i <br /> (Complete in Triplicate) <br /> e <br /> kVitcatlon Is hereby awri, to Sao Joaqufa County for a permit to construct sad/or install the vork herein deeerlbed. This j <br /> appllcatlon Is made In cogpliance vlth San Joaquin County Jrdinanc* No. Sig sad 1862 and the Rule* sad 1teRulatlowa of Baa t3 <br /> Joaquin County Public Sealth Services. <br /> 11111 Al t e t <br /> Job Addrga ' „� . Gtt�j� Lot Iilu/Arreaae�C'l( Q t � <br /> h <br /> tJwn*r'e Nems f ti �.y�� Addrau J L l _ <br /> if Pharte � <br /> Contract / /�/' �/ _/ .� <br /> .� 1 Addreta �r,e.. /< ^ Uttn/f"Of � <br /> TYPE OF -I.I./pumpr NEW WILL ❑ WELL REPLACEMENT 77DESTRUCTION O Out of Service,yell <br /> PUMP INSTALLATION O SYSTEM REPAIR 0 OTHER C Monitoring Well O cc <br /> DISTANCE TO NEAREST: SCEPTIC TANK SEWER LINES _ DISPOSAL FLO. PROP.LINE <br /> FOl1riOnTiG:V AGRICULTURE WELL OTHER WELL TITS/SUMPS <br /> INTENDED USE TYpc OF WiLt. PROBLEM AREA CONSTRUCTION SPiCIFICATIONS <br /> 0 Industrial O Open Bctterm O Manteca Ou.of NON Eacevetlon Ow.of'WiA casa%' <br /> I Donwaetic/Private ❑Greed Pack 0 Tracy T <br /> YM of Catxnp__ SpapficaisOr.ii `.. , <br /> (.1 Other fl Dale Uepth of Gioto Seat _ Tvpe<,t Gr yw <br /> Irony.,on _Appros.Depth 1 I Esswn Surf me Sed kutaosd ti <br /> Rapeir Work Dom U Type of Pump N.P..,_,_ Sun Work Oar►_ <br /> WWI Destruction O NON DbmatCte Seelleq Material 6 Depth <br /> Depth •111er Natertal d D"h <br /> .-^c-..r.....�..—.� __ <br /> TYPE OF SePTIC WOriK: NEW INSTALLATiC:N R` REPAIN/dD01710t!i r DFSiAUCI'tON r i th>yah rc y.;;n �ornuttrru u;;.ril:w yvavw u <br /> /� av*ilaoh taai7rlrr:.r"JO leet.l ��. <br /> Ir.,t4::Zr.,,n W�iy 0.irrA: /ier,;7erlce F_ LVrtv'wfCiAd_... OjttN / � . <br /> , <br /> `umber ut Mv.n;,urns: .^. Number of ttad.•acrrte,� � I � \ <br /> %ha:xta ua coil w a�0 of!4st: .,jar j. Ir- �� _Wgta i"w Ww:h <br /> P .�YIC i'i P X j Tara/Nligi 1r i t .L+( No.Cw-41mcwolit <br /> iui(G.1 nFitTivlEW?PLT.7� / / kAatlro4l of <br /> tJiatcrrce 7p rrrarser: 4YeY_ �,_ Fourxralran � '+roO+RV LYM <br /> LEACNINO LINE �v �u. W L wgyt:r Crf tr it 7—2/1 <br /> .---=-s� _ _ Total Ian thla�p <br /> FILTER 6E0 Li Dic4anos to rws •61: WW ""i <br /> 1 -l'• Ftwnwtion _ t'ttlo"Lkw - <br /> _ /' <br /> 1Lf1EPMU PIT$ �� `--- <br /> Dth �/..�_Sire �t Number / :I`i <br /> SUMPS r _. <br /> LI Dieter"W r+wwi: WON/"," ftwndstwn [4,: Prt,Lymgv Lw `_ r <br /> DISPOSAL PONDS O <br /> 1 hereby(6nify that I raw Wcpar.A ttly*gi':w 4r,.On and th*t ins wtwk"be dune to uccrlyderroa w+th:Ian J4irGuiA County woimn;�o,u:=u fir.,ar4d <br /> rules and reguts:kwa of trio Uan yu!uin +treaty <br /> Nof"onnwr or Ryan W ;m'a bignatuN-cartif."vw foaowwrig:"I Certify that in Cru I;orfCrm,wtCa of thu*otk for uRkch fico parrm ie etw'u'I ti. ti,x k <br /> dmptoy env pW'fr:Rr k5 OrrC.ti nt.^,aw'1x3r 83 CG b+.;t Iry iw:;I:.i:t is wG1krr*A's cornlors"Iiol buss 01 Cakiorr a."Cmtvaetot's hkkp a <br /> ea:uPiaa Ina(040 rtiX:"1 CONty t Alt in thv Pwrrla»urnce of the work for whloh this peNtnlI is Iwrrsd,1 ahaN sny�ioy parsons subject toto <br /> lion 4w%of c"'IO 4." Corr4 i.rD• <br /> 'Ino ay1okant t Cott Vol .A u!r tti wra;xtariarts.Cortp+aw drswwtp on rever"tadr,, <br /> :;iCncd X,___-- .r, Tltw:— — Dais: 1., •� L I r I' <br /> t < ?011 0iPARTMiS'iNT UL'il ONLY L <br /> Applicsran Accepted Dy ,etr Dat Arae •!.'� <br /> y ��� .. �� � <br /> �Ialiptr grout WAP"IWA by I ~ r 'fhaft:' r. <br /> V .�--4�' irrspearion by <br /> Additio"Conrnonts: <br /> Applicant - Neturn wll eoplea 4o: San Joaquin County public lteaith dervlcoo <br /> Bnvlro0meat*1 Health Pertrit/derviceu <br /> sac ti Nam Ja44ulm, p,Z.owr ROW. dtka. CA W6101 <br /> 111 <br /> u" 'taNY 6Adk>VNT 11ard1TTl0� '^C_ 62 i I_.r�r ,��rr1�'`.1�1 ►ERYt11'NO. <br /> .EH 1124 IAN.ri■,i.AE J � �,/�� i i/� j6�'7►/ �. ,.�.� <br />