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<br /> APDL I CA'I'I(IN FOR PUILld 17'
<br /> r. SAN JOAQUIN UOUN'I'V 111311,10 IMA1.111 SFItVI(!VS
<br /> kN V I It(It11ga119'AII ItLA1I'll 11 1)1 V 1.31 MI
<br /> 1601 E. IIAMLIVI AVl;. , 13HOlIL: (:3011)4110
<br /> 1t U 13px 2000, 8'I'OMYCIII, (:A 7151301
<br /> Li;a�czr_��t�i�sl�>S�._xan��..xt►s��._a���,.xr�t�w�
<br /> (�3n1n�Jloie Su T1•lplianie}
<br /> �-- A),pllreltan 1. hef tby 'wils to Stn Joaquin County for s pormll to Collet rust nud/ar Ina to 1l tl,t VLA If Les t.13+ Ager,11 tJ. 7. s.:
<br /> aPPIlo►tion 16 sails In ooiw4l.nee Vlth 84" Juuqufn Cwmlly Ordlnifnee Nu, SGy .nJ )602 .ud the Il,.lra u,4 flenu)etl •A 1:. .
<br /> .4-Aquln County I'%' r, Reellh Ocrrieto.
<br /> ,,,,•,
<br /> Jot,Adl+rey _%Q141 1S`�"Y__�:a/_'�'_ .. ..__.._._.... rny✓ L:,1 Si tsln.l,,,,F;., _—__._._....
<br /> t)wmar'a Noma .S..L- �C b {.+.s_—.. Addrlltt _ 6�f.-!__".�_!,CI�Ir.�..,C_i*�Yitf,.•_ �'hohw�G� IQC_..�7�5� II
<br /> for. G A2 I ?ti�l��—r1!`ddd,ec� s1 �.T!f•� f.'r �7/ Ccri Io �J `V I
<br /> f— J _��s�I�_�i.lLfrl...LelCnsr IIo T.9z�1'hhnr(�.�I+.
<br /> + TYPE OF WPUMP: NEW WELL Cl N1LIl ItE1dfN1 fl— Ol'S1IIl1CTIQfJ L'i fTr
<br /> EM [PIACt nr hart'ice ue31
<br /> ----- PUMP INSTAtLAT�I1p I n S`r5 FiA IIEI'Ain C) OTHER tl Monitc.riny, well ,I!
<br /> w DISTANCE FO NEARE61: SEPTIC TANK MAI SEWER tllJ6s\ S4Ar,i ��11 DISPOSAL FLp.NICti._ PriOP LINI; id r
<br /> FOUFJDATJON - AGRICEILTUAQWEIL _.. OTIIEgVVCLL,.ev . PITSISU_fil'S
<br /> INTE14p_ED USE _TVPk OF WELL P_R_O_9lEM_A_RE_A C_ON_STnUC_TION 5110f ICA ��`
<br /> Induu11111 F)Open f3ottorn n Monlece 011, or WoG E,t► etl�r,,_ ��...�_
<br /> '�------------ Ilio..(Welt c'pa"11
<br /> 1 11)urnullc/Privlle L'3 GHvol Peck 1l Tracy Ttpe or Cetulp•-.1�lll,_! 51.mIicohon6AyI?CrCvw21
<br /> I')Puk,tic k-3 Otlmr I'1 Deh■ Depth at fluid Swat »,5,�� _ IyPI of G)oul r
<br /> t i iuUjbnn �E Anl,lo■. Do y l�� n I Laar., 5uttara Saul Installed!,r
<br /> lteplu WotM Pane U lypt 0l Pimp K if P. 51016 Wa,k Dono
<br /> --- ---- --- --- A�
<br /> i'r Wall Detlluchron CI Well Oiu_nelmi IJeallnd Ilateri■l 6 Depth '-•'
<br /> 1Demh I'tller Material i Da t11
<br /> o-a JVPE QF 5EP IC WOHk. NEW INSTALLATION t I HEPAtpIADp15014 i 1 OESVItICilON I I INo tapue t}lurn parmenn l rl p1,b1,t tm„r Ie
<br /> - - avedbk,la r.dl+iu 2{10 loel.l \
<br /> —1/1ata11e110n will ICrve: Riesidence Commorclol— Other
<br /> Nuolbel or JlVlllg untie•, Number at o6uroomt
<br /> 1" Chi)/clef of lull to a depth oe 3 Teal:_, Wolof table deptl,_ ___-_,. a
<br /> SEPTIC TANK a r elMrg _..._.. `
<br /> .. ._. Y'P .--__.,.-..__.r_.._.....--_...._ C►Va cnV_.._,,,..-._._-. fru Curhpuln,ente
<br /> t
<br /> PKG. THEATASENT PIT.Cf
<br /> Oislance to noal6et: Wa11 Pl000lly Lire
<br /> LEACHING LINE Ll tic.6 t.m+gth of lineaIlk TER SED IA alylane6 to I1111act: Writ J§ullellt'Lina
<br /> ('Jl
<br /> SEEPA09 PITS Numi6r
<br /> SUMPS E:1 01,61eltcer to I,alrett: Wall P,nprrfy 1 n,6_ _.. _•.•-.._.
<br /> DISPOSAL PONDS 11 ...._--
<br /> I I+aroby sanity that I have V)epefod Ihit opl'Ircallon end the)the wofk will La duno In ataurrlsnC6 wnh San Jn•r)uln cuunly old,nenta,l.tela I...
<br /> Whit Ind fouuletions of the Sen Joaquin County
<br /> Ilmoe owner of licensed agenl'a elanblrno cu6rin.the foL'owing: '•I Culify the,In the Fwrlalmenth UI fl,v wurk fol whicfl[Iul I+arnut It Itswd,11h1.B 1,1
<br /> _ en,Piny any loatlon In ouch manner at t0 become Hihla Cl 1u wul)tmin'1 ComPe nl ttlan laws 41 fhilnne. "Cunllltlor's Imiuq of Job tonl.prhr,yl$.whalr..c
<br /> caro,lae the following."1 Con,fy Ihel In the s,ariormence of the walk for„h,cil Ibis p.ffuit 11 issued,1$hall elnplay pslsolll eubleLl to wpe$n,an1 cu,rll r;,la
<br /> lion liw/it af,lornla:'
<br /> Th/opplicirtimull Ball for 1111 uqulrltlkir,tpe[qloll, Contpl.0 drawing an isvera•side. q/
<br /> Signed X T I`yJ
<br /> I).,a
<br /> �(�IY J (1 f !
<br /> F r,1
<br /> )11 EPaTtTENT 106E [IHIV 1[/
<br /> I Applisalion Accepted by _ r �( �t Do+e 9 ! ! _
<br /> J PH or 0I0u1 1Jnp+t110n by Fink,Intoo tic.,bV.._._.... .-.• -._._ D.Is_
<br /> s
<br /> 'Idon1l Cammanp: •_ _.,,.,,,_„_— _._ -
<br /> E f pllcant Aa turn ell capita to Ban Joaquin Col-Ly Ii,blic Noalth •�
<br /> ' Hm•vlw. la,vJ ryl.elb lrt�] Hewlih tercl t/Set $ror
<br /> �. ltiOT t. Raeeltoa Ave.. P 0 Itoz 2009. Stmck"If. CA 95201 r ✓E
<br /> i-.{ FEE AA{010161 DUE AMOUNT r([MIt'TLO
<br /> E 11110 _ Ca51+ 111 ntCE1V[D 0�' Gal[ 1.PIRr.pt ftp - -
<br /> 9 I Si1lilty f1. .�•._ ��.1•.-...._.... ...µms-..1•....,..._..
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