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05-05-1995 09:51AM FROM TO 1'7144'768211 P.01 <br /> !9t'r,Ll%-Al 1.UA <br /> SAIL .J. i ill C0UNT Y PUBLIC: dhAL'1'11 CE5 <br /> ENVI$ONMaTAL EEALTH DIVISION <br /> 44b N 3AN JOAQUIN, PHONE (209)466-34:&0 <br /> P O BOX 2009, STOCKTON , CA ,95201 <br /> PERMIT EXPYRES I YEAR FROM DATE ISSUED <br /> (Compleze in Tz-iplicat�--) <br /> Jpl caLicn is hereby bade to $&a Joaquin Cou3ty for a oer l t to -onatrLct and/or install .he work herein deacrlbed. Them <br /> applica:icn is made in CCUP11anCe with San Joaquin County Ordinance No. 549 andi1862 and the Rules amd Regulatlons of San <br /> Joaquin County Public Aealth Services. <br /> .b Address <br /> 1 Clty�����' Lot Size/Acreage Cf, 3�k C•t 2 <br /> /I ,{ <br /> Owner's Name l�yllzCi�V1 a-tV0A;a �arlk;Ado,ass �C� ' �tc41Y\ J�. �1L�Ct- PhondI ) 64 <br /> �ntraclor Ness ZCt1 S�`ZT��X��4Nddress t ` �u`� ��'l'��� C:(C.rr�►tliAictrise No. Phonot(,)373��11rc <br /> TYPE OF WILL/NUMB! NEW WELL 0 WELL REPLACEMENT (l OESTRUCTION Ca 044 of Service Well O <br /> PUMP INSTALLATION 0 SYSTEM REPAIR O OTHER 0 Nonitoring Well g <br /> ISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL hLU, PMUP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> iNTENOEO USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> Indurtne+ O Open Bottom 0 Manteca Jia of Well Excavation Ctnc.lvis Oia, of Well Cacng Nin <br /> Oomest+crPrivate L1 Gravel Pack* A Tracy Type of CASIng- Nva Specifications <br /> t Punlrc tP Other beG.t,,les C) Delta Deoth of Grout Seal 1C Type of Grout..b�Al Tn, <br /> 1rn�anon t: Aoptox. Osoth f I Easto(n Surface Soul IAs2aued by <br /> gala wn,k Done �3 Tvoe of Puma N/,% H.P. --. . .._..... .-. ...._- Stats Work Done <br /> Walt Destruction n WOO O amater Sealing Haterial 1 Depth �p <br /> Oenth ---- Filler Material 1 Nepth -f- <br /> rPE OF SEPTIC WORK: NEW INSTALLATION ) 1 REPAIRrAODITION , I DESTRUCTION lit (No septic System pwmitted tf public sower is S <br /> available w lhm 200 leet.l <br /> Installation will serve: Residence _ Commercial_ Other <br /> Number of living unrts: Number of bedrooms <br /> I `+ <br /> Chafed Water table depth <br /> SEPTIC T Post-it.''Fax Note 7671 Date ° � 1 No. Compartments <br /> 5•'S•Q5 <br /> a :G. TRETo 12. PrL � From1 Method of Disposal <br /> PropertV Line <br /> QOJUFPL c;o. SSL <br /> I FAr HINT Phona ll Phone <br /> a Total lengcn/siz• _ <br /> LTER 8+ Fax h L l Fax z Property Line <br /> '1 t 7tp <br /> SEEPAGE Number <br /> Wimps LI Oiatanes to nearest: Was Foundation Property Line <br /> SPOSAL PONDS O <br /> . .iareoy caddy trial I ha,e VroJar*4 chis apoli"iwrt end that Via wv,l, will U.Jvne in 4—iiiartcn win Son Joaquin county ordinances, state laws, and <br /> rU141 and regulations of the San Joaquin County <br /> "oma owner or licsnsad agent's signature candies the fotiow,rtg. A candy that in the performance pf the work for which this permit is issued, t shall rat <br /> 'lploy any person in such manner as to become subject to workmen's compensation taws of CalAelrni , ' Contractor's hiring or Sub-contracung signature <br /> rifles the following: "I-artity that in the performance of the work for which this permit Is issued.1 shall employ persons subject 10 workman's Compense- <br /> tine laws ref CAlJorn,a" <br /> t I <br /> The applicant must call for aN required in4pections. Complete drawing on reverse side. <br /> )mad X 1�< N l=1= ��L!1�.��J / l.t,v �, yr .,Y�itts: l t }r71 t.y\r( `(' Qate: <br /> ,1 (� FAR OFPARTUFNT USE ONLY �•" <br /> t l N I <br /> Dace /� 1�! t^ Area <br /> I plKattOn ACCspled by <br /> or Grout inspection by Date 2 `��^Final Inspection byOats •/'^ 1 <br /> l <br /> °110111onal Comments: <br /> Applicant - Rocurn all copies to: San Joaquin County Public health Services <br /> Environmental Health rermit/Servlces <br /> 445 N Sao Joaquin, P 0 Box 2009, St:kn, CA 95201 <br /> ov556t <br /> 'L INFO AMOUNT DUE AMOUNT REM1T'EO CA RECEIVED By OATS PERMIHNO <br /> 1age 13A <br />;m 13,2 IRP/Ari 14.af `1 <br /> IUIHL H.Ul <br />