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D ti PSIVE01 . APPLICATION FOR pFsMIT ��►�'i4�t,,'?� <br /> N COUNTY PURL I CECEIVED <br /> lSAN JQM ROMOTAL RMTH DIVISION �I <br /> 445 N SAN JOAgLTI 1, PBOHB (20B)Asa-$420 <br /> OCT 261992 <br /> NOV 4 9 1992 CA 95201 0,AN JOAi�IJIN COUNTY <br /> P 0 HOB 2009, STOC$TON, PIJSLIC iJE LTH SERVI^ES <br /> ENVIRONMENTALHEAl1H I VIRONMENTAL HEALTH DIVISION � <br /> PERMIT/SERVICES I <br /> I (compaetv in Triplicate) <br /> "a/6r Install the wort betrsin described. This i <br /> Joaquin County' for a parr"t to construct end/ tions Ot sen <br /> Application Is here* tea -U r ot,n County Ordinance sa. 544 and 2662 and 4be ltvisa and Resole <br /> spilicatiqu is Mae in CIPW I tQa Stir ear+ Jos4 � I <br /> joKuib county Public swath So ices. d. 6 A C <br /> 40., PAC ��• N Lot 911E/ACreega' <br /> Job Addtea i t <br /> ..43 _Lr,L.- Phone <br /> Addrelf <br /> Owner's Name C•r II <br /> C 4�` idense 140. Pc <br /> ddresa pESTRUsrTtON Q Out Of rr ee e11 <br /> Contracts Vt WELL REPLACEMENY ztolir Ifela a <br /> TY E 0 W LLIPUMP: EW WELL ❑ OTHER #� ,t'' � S <br /> SYSTEM REPAIR A PROP. LING <br /> PUMP INS AU.ATION O 6EWCR LINES —.--�-•-- 01SPOSAL PLO..._,..-- <br />' DISTANCE TO NEAREST; SIPTIC T+�kK -r-•-�- Tt�6f4 W1 tk PiT8/BuM y <br /> pOt!} pATIC>µ �- AGRtCULTIIAO W�eLI <br /> TYPE OF WEtt PROSL� EM ARTA CONSTRUCTION SPEGIfIG TION$ DIS. of WOO � 0 <br /> iNYEN010 USE G7 MlntsEa Die. of Wall excavation <br /> Cl Industrial Q Open ewton► Type o1 Cae1n4 x^"`� St�eeNkstions <br /> L"1 Tracy 3pr �+L Type of o ovt,., alACa"` <br /> f.l Oomea[w/Ptivite Q Gravel P01k n Detre Depth of 13taut Seal . <br /> 4'l Public Ci Other v' <br /> Approt. OaPth I I f astern Surface Saai Itiasalted by <br /> I I Initiation ""'� H.P. State Work pone .. <br /> flepaif Work Dane ❑ Tyve o1 Pu p - holing "&tariol A Depth <br /> Woo 0eetruttlon D Well 0lefnaler ...�-••- )laxer statertV fi 007th ! <br /> ppth <br /> TY fi Of SEPTIC WOfLK: NEW 1N5TALLATIOhI I 1 REPAIR rAgDIT10N 1 I pt:sTRucTION I availsb���hI n ps06ttfed If p.�t�Iio 'If <br /> Inatt"Oon VAII Serve: Reatdertt a T CornmefcW ...... Other <br /> Numbs+a+ lMnq unln: .._. f�urrtber of t�edroort+s�� Waat table depth j <br /> Chvaeter of sett to a depth of S feet: CelwifY�� No. Cempstttnsrtta <br /> ts%PTIC TANK. 0 TYOs1Mt�4 Method of 011po+►a1 <br /> Pttt3, YRfJ,YMENT PLT.0 I Ffopertlt Line��---- <br /> C14tanea 10 nearest: Foundation <br /> Total lensth/sl:* <br /> LEACHING LINE ❑ No. 4 L ngth 0f tktee Property Line--.- -� <br /> FILYER aflD <br /> it Nomme to nearest: Welt, Pou"40WA_---- ----- <br /> NUMWF <br /> SEIIPAOE PITS ( I Depot PrapUN L'trte <br /> sumps LI Dlstancnito rwrest: Walt --�� Foyndatlon A---� - i <br /> .�_,.• .. I <br /> QIgPOSAI PCNrti>d - <br /> I hMeD7 artitY that I haw Preperad thlA appllcatlon and that the work will be done in aacofdanto with Sar+.7aaquin County ordtnsrKas.•u�r shall riot <br /> ruies and repvlatlens of the Sin J"Cluln 00=%y rfatma Ce of the work 10r ryhlch this pertT+i1 b lea nature <br /> wbjact to,vorkman'a mbpensstian laws of Cafilofnis."C4ftira grin hiring or fu�aontrazt�W <br /> HorM oyyrter or licensed et;artt'$signet fa cenifilra the folowinq: "t tle►tify that in the oa <br /> employ any pmoGn in aurh nm"r as tpQ f�7+cot�ts <br /> gsrtlllsa the fo �Ir�p�:•'1 6ertif3l that In t}te pwrforrnanee Of the wbr4 far which this permit is issued. I$halt rmpicy pprabrta subject to workman's oornDatti <br /> IW,h IOM Of Ctt1M NOrnia." <br /> s, Complete drawing on fevsrse side. <br /> apotkant roust Call fAt alt required tIP!ct+or' Date: 4&4 �2— <br /> TheTitEe: Q�" <br /> Signed <br /> FOR DEPA W E l <br /> - <br /> Apptlwtton Accepted by Dote <br /> Px or Grout tnfp+ctb+► by I <br /> Final 11110e066n by <br /> Addhtenat CoAlrsMnta: <br /> Arviicsnt - satura elx coy�es tot SRO Joaquin County Public health aervioeo <br /> tdsvirosm+ntai Heaitb Detroit/Bervleed <br /> 480 N Sea Joaquin. p Q Sox 2000- 6%kn' OA 915201 <br /> FEE AMOUNT twt AMOUNT PtimsTTev A H <br /> Aletivio Illy DATE PlpMlrt'MO. j <br /> tNFO ! <br /> . sr+trlttesv.Fr�trf Woo 3j <br /> eM,rss I 1 �C I T Z6i60/ t I i <br /> t0d 968# ON]-1-116(I snt1H`1I 0A:ON -131 SL99-969 8Tb:G I 0b:t T NOW E,6,-60-ADN <br />