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3163669657 TANK PROTECT SAC 994 P02 APR 27 192 i'5: 18 <br /> app ICATION Mug 414",4 <br /> 8A 1 ,�Q QpxN COUNTY PUBLIC OALTB 3fMCPS �►"�t l�►..- },1�..�.�."+� <br /> NNV iRO MTAL HEALTH D VI iS I DN <br /> 3.091 -XI 04"TON 44VE- r PHONS (200)400-3420 <br /> `P 0 MOX 200 , STOCKTONt CA 05203- W <br /> Caul dot iu Tripl�omta <br /> Applicatioa to hertby 1Aad0JO ISO fgKl n C"fir for a pe <br /> rtnit xlr oottatittct }pcUpr iuMto] SAO track beseic d*#aibtri. Thi r <br /> app111atioa 3a tt,adc is 000/14499 y1T,b 8af# JppquiA G tY t];dinas.99 go. A9 /tld t11b2 tial sh# Rina* and no- 3af004, of so <br /> 110411: County public ifNa't4 forOtt ► t <br /> 2� 4S Cily a' f~oi If}#:#/llpra49 <br /> Job Addraaa <br /> Addy faa 2S -J <br /> owner's Nama C-CY CA 10 <br /> Ile <br /> -£ontractor <br /> ­S- C&L2 L• A0906 tv,0 f_!R.�51sw tL a - ICta:o Nd. PMtno •• <br /> TyJJ OF wEtt� In <br /> UMP: NEW WEI I.` 17 WELL RFPLAC>sM NT p� TA�JCTI¢N Q Wx MuaitA io,wall Q <br /> PUMP IN TAI.IA►T4QN SYSTEM REPAIR L) QTNJR <br /> DISTANCE TO NEAREST: SIPTIC TANK ..��� I��YVIiR ONES � -�. OT14O 8Al fil-L}..w_, PITSIPROFLINE <br /> FOUNDATION ' AGRICULTURE WELL-�.�.� OTIif:R W¢LL...�..-.�- PITSrfiUMPS <br /> INTENDED U8E TYPL OF WILL . PRO LEM AREA CONSTRUCTION pfiCIFICATIANB Dia of Wplr C1f+1+W <br /> Cl Industrial �� C1 �11 p909m A . ..n11i3� DIO. of W11II E><4ay#tloil <br /> (:i Domemicipriv*ri Cl GrEvo plod M TS�oy Ty"of Cooing_ Sp*tiiflp#hRA# <br /> Oepth �i Gr S Typo 910041 <br /> 11 Public Wer n Diot <br /> -� <br /> ApIK?o• R4psh I I EliltRrn 15urf#Gt Elul Initollod 1iY <br /> t <br /> Rapail Work Dpn* L.] TYPO of PUMPr..` Istat? orE Pont" <br /> H.P <br /> Wew Daau4t:tion 0 Wail Oiwmlrt!► t filri►ll:p II*t*rtpi i AopGh �-.4 � ,. <br /> Depth i Ytu9r t4atariay b I � <br /> RrAODfIONl1 DOSTRUCTlN1 IaY#1I#trNr wilm tt*d I, public $#war Is <br /> TY iOEA tWRK: # WNSTAIIATIAN AEPAItta je <br /> tp#1► <br /> Inatoozion win"No: 144000 . _ 010m"?9111----- Other b� <br /> Nymosfi Of pvina uMk*I �..� f lun►p#r of b 4rQor1lYw.. .�—� _ <br /> Charaucr of wit to dapdf►Af 3 faal: I <br /> 'wow 1#1'1111 depth ; <br /> SEPTIC TANK 0 Typo/Mfg t Ccp4citY.�- NOCgrnp#mW11 <br /> PKG, TREATMENT PLT.0 M04 of D400#1 <br /> 01it#ro4 tv Wr"11 Woo Found#Iion.M. PlOWlY LIM r-�-r- <br /> Totallo th/649 ' <br /> Lt2ACHING LINE Ll No. 4 I-cngth of Ilnas --.,.._, ... - _., rW <br /> FILTER BED L7 0414nca to naak0*t. W*Q�._ foundation— liworl.Y Ont �--�- <br /> 1 <br /> ttEEPAriE'PIT1i <br /> 11 Popthr ai11# —..... N4mbw <br /> BUMPS LI 0iaranaa to n#mom, W48 FourtdaddNl Prt> rtY in#... �, <br /> ' DISPOSAL PONOS 0 1 <br /> I haraby canify that I havt pripar#tf Ibis oppikoklon 4nd 141 Ih*wvrk wiA br 0014 in fccA(drot vvllh 4",14#p4Ir)rro4lntY arrlirMn4pi, t'1 to Jaws, and <br /> rulai:nd rogulation*of tho Son J944min agunty L <br /> Homa owner or ocon wcf 8"m10 cipn#lur*eeni(W th#10119wina;"1 cortifv that in the I4rformanc*Of th*work 101 Which 001 P11mlt It 104441 1 SW rot t' <br /> amps/y any person In#uoh mann*(0a to I)OOrm*,40*at to workm*n'v 4arr"novlon 1myv*of COW*-"Coofrl Wee hMlnpl 91 autrcontraclin9 tignewra <br /> oamlirs th1 fosamog: "I voroly that in"p*rformonGa of th*work for which chi#permit la ivlu*da 100#mPl4y p#+ipn�1u�ijfit i to w�kman'.aompanaa <br /> lion taw$of Cali,O 0. <br /> That appOoan t 004 for it d In1p#otiona. complato drawing on r#varafl aide. 4 <br /> SipnrdT1tf#I GA-LI P#t$: G f <br /> FOR DFPA"' TMIFNT US11 ONLY i <br /> t7� <br /> AppliceiWA Aocrptad by 1?#1* Are* <br />- Plc of Grout Inapactlon lDY �?Luazt;/.�—,_,. t)attp <br /> S Z final In*pootlon by Q*ta <br /> 44dh"Al Comn30014: t" ' <br /> ApplicsAt - 3toouvm *12 oopiaa to; San Jotrgpia County Public Health . <br /> 6iryicedo sartrotlra#aial acalth 1'armitl6rrryico* �.q,0v <br /> 1,401 X. Apspltop Av*., p 0 Dun 2019, sto4tab, CA 95901 <br /> INfp AMOUNT PtIE '� AMOUNT AOM►790 A ftECEl�90 r1Y DATfi PENMIT'N0. <br /> . rte 517A IFFY-�/�6Y •O:q . V r, <br />