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t©'d i-101 <br />APPLICA`PIO <br />SAN JOAQUIN COUNTY PUBLIC MULTH SWVICZS <br />ffilYiB T'" HEALTR DI VI SIO [ <br />4-15 N S" JQW=N, P (209 i4"-3480 FAX (" 444 o t,30 <br />P 4 BOX 20M, STOMM , CA 95201 <br />(Cosuplete in Txiplieate <br />AppLicatiea in ks7cIW �'O.su Gm tyttsoul.s CQifn'Ly for A St Lo vcmLruct 614/or inste]1 the trcrk t+sraln described. Thi& <br />%WL%c"Laaa 1s sde In ealp1lasce with Baa Jaageitt GiAfi'ttiy Ordir M*e No. 549 ands SB6E own %Am Slta mW BEypL7atDm9 or Sat, <br />JC@Q=n armm"r poklur s alto SwrriGee. 7 /� <br />.Nob AddMaa g � Cevn t ./ 4v, L 6tp �i" y3 lot sise/atcawsor <br />+ 'e Nisa+e s etvN if ('" Addrem F i i4 � �4'��t yd, Fnwe ii�� --4ft <br />iw S4:sem <br />7VR€ OF VVEi.LlOLRAP: } NEW WELL 0 WELL REPLACEMFNTM OES'CRUC ION C3 0u% of Service ife31 C3 <br />PUMP INSTALLATION D syvem�gvs C OTHERisr Kant-lAos re1.l <br />DISTANCE TU NEAREST: SEPTIC TAMC SEWER LINES ;7f d' DISPOSAL tLB� o pwo, UN -E 10 <br />Founo noN S� r AGRICIJLTWA WCLL �W OTHER Y�f�t Ese. "TCHSUNP3 <br />INTENDED USE <br />n inda,:tria� <br />f;l bDIl146LiC%�riYit! <br />i } Pt�ic <br />t I Irras}stbn <br />iispw AMM DOM <br />WON 8e1111ru y m <br />r -1A <br />T Y?K OF SEPTIC W1 <br />TYPE OF WELL PROOLEM ARFA COHSTFUCT±ON SPE0FICATIONS _ r� <br />C7 Crpen Ad vel C7 moffto Dia. d Wali Ewcauaowt Dia. of Vtr¢rl <br />fi Gtasrei Pads Q riecy Ime of CO►irry NilI3petitilifxtioeM <br />fW R' Oeha Depw of Gram Sea[ &EIL IN 00Tv" d ct=-gr.tzo tr, <br />pp� v - • , <br />�,ta+byFrpx. Depsh f i Eirit�+tt PFtrf�6 >}p9f ►nssatlatt a1' 7 <br />T"m o1 Ttanp j2M H.P. Seale YAV% Oona <br />VOW PLwmter _fl Eteslislg Materiel h Dervk <br />ow1b - 16 F- �.-r Pix. = 3wtcriaT i Ars+ <br />fAW 1NSTALiATf0 N I I REPAIIIIA001TION I ) QSSTRLiC i7Wa1 f flew 4wIiC systtsnn Ca+sr,eletl it taa11YC teru�t b <br />aw*UtAs wkrkLi 200 leet.l <br />Lmottfim *3 swvei C* — i;%W� — pricer <br />Nutmw of *VttG unklu ._,_.__ astsnlanr of bodwW x <br />Cowm9 m of eoa W a oat sat 3 seas: -WAM- *bWolath. <br />SEPTIC TANK C3 Typ*FW CapaC2tY No. cemodnrwns <br />P90. TRSATMEN[r PLT, a YertoB of Cglaatl <br />orasancs to rtovwt: VM1 FWAdmion howny Urn <br />LEACHNG LIMK Lt No. as L. vdt of ones 'raw lerrgttdsiae _ <br />FILTER ZED 0 ftunas tF noarm, Fduntladan PltaartY 4he <br />sup4m PR/ I I p"ti• ----S Wdhhar <br />SLMIWS l.7 Datattas 10.90-: Wali Fo.u+daem+ - -- Ppoparty Lena <br />AL HEALTH <br />1 nsnby CM07 ttwe I tu" paxparae ►ins *M kaleon and the: ehts wwk wilt to aiem In onepeow#'na with >Laa JaWtin a mt1y ardntltnM stats laws, Bnd <br />eubs ane et0uk6aets *10* San Joaquin ixtmss <br />KOM WMFW Or iiaA110di IMM'+ t;+g AMn t ae Ins fallowing: " I CWWV lhat M thN PniCrmsnra of ehs work For wAsid1 vtis pwetnie is iswed. I " rw7 <br />emtikoe afty oeraon in such manner as m bkwm cubpa 1a wnrtnW'a Cp1f►P10I IkM &M 0i CMNMIL" COMnGwa liiFYtg a 900 -to iradiflip 204atrwe <br />conMla we IOUVIMV: -1 =fwyr dWlg it+ Ota p4rmwwm ae am want enr o+tieh the per"* * oared. I *M an*kW posms wojeat is workmmn's cmr4 w- <br />tion hr" of Cao <br />Tto aWkA t R tOr alt 9 itxte, Camplsea dawn* an traveras sida. <br />5"dX_ ACW'r- per: ` Q - i'tlr� c =eJ� DMI <br />FOR ORJ%RtMEN3 USE QAFLV <br />Appo" wn Appppmd1►Y Dam7 Aro <br />Pie or meal i, OF 6 pp Fina ■wp wfan by Date <br />i <br />I nedtiea+sl Lbrfi«wrtsra• <br />! Applicant - Istara all oaptss to: Oak .ieegria Cuunt7 Public Hemaik 8arvioee <br />44CilrokUMJ l �&, P karaeiLlBN:e�t3eetF �j ' w Lf � o <br />/ ( sn0 p +kstn dtraquia, P OBel[ 8009, t3:tn, CA 952p1 /I 1' `\I! /L.Y l✓ <br />a AMOUNT PW WMW OtsmrTTwCAWptcavm Fry DATE00C I <br />R` PFR>afJf NG. <br />EN 13-A fLEw. 17 rD <br />J <br />:ET <br />oSC�J'd01 n T5 UI; but 111..1066--FEbT-�t'-G <br />