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P 07/24 ,I 99E 11:32 FROM TO 12094640i f.9 <br />required eta chewing art reverie side, The 'Klement 'rani oil for <br />Trtla• Pitlf-cSitl 7-- <br />FOR DEPARTMENT tmlF ONLY <br />Ostir 2_(1 `tC , <br />AMOUNT DOI ANOtPrt REMITTED <br />Emil Inspection by <br />told- la- <br />APPLICATION <br />SAN JOAQUIN COUNTY PUBLIC IlEALTI I SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N SAN JOAQUIN. PHONE (2e5)-46m244e2o, <br />F 0 BOX MS, STOCKTON, CA 95201.-0388 <br />2,1014111_,W___Larkaj 1M FROM OAT II0tD <br />(Complete in Triplicate) <br />Apptkvtion had, made 10 SO JOliguin Gottaty for a permit to construct and/)r inctall tile work bereist described. Thit apPlitalion it made in cnterliartee itith Si <br />.kt,,tvila Comity Deyortmenr Title Section 94410_3 spiid SA,skidgt.11.15.3 grad the Rules and RttitiLitious of San Joaquin C.ounly Public lI1ib Sergiteit, <br />I hereby corfrly that I hive prepared this aocAtation and chat the work will ha dona in accordance nriM•Sen Jutim.iin county ordinances. EU woo, find <br />islet WW1 tegulatiOne of the Sin 3osouto couoty <br />M Soma avow. Or ItetWO4doeonee tkittatera certifies the following: '1 certify that in /ha pa ilorreanc• of the work tor which 1114 permit is iared. I shell not <br />eroglerY any Parson in IRiett memoir tri to bamm• subisat to repairers', comOriPletkul low* of CorPfortits... Comrsapro hoytttrossokeootrocorig *row* <br />cartrias rho following: Icor* that In the parfOtmerNe of the work for which this permit is issued, I shall employ moons point to yyofk otoril oompoosa. <br />don Imes of Cabiornis." <br />Signed <br />Appillaidon Acappted In! 11 Jite <br />POI or OnNA Irkipsclion by Date <br />()L4 hu.5 eivrcrAcktypard <br />- Return all C'OinC15, to: <br />Cie $34!/ OMNI. I • At) <br />Arbor* Dorroostits: <br />APPliesat <br />INFO <br />5 <br />lAkocuf <br />nEcENED By <br />1 <br />DATE PERON', NO. <br />136)c(c‘Voi I= C4'3 <br />Sac .Towicia County Public Health Services <br />Esviroartu.nts1 Deed; PerotitiServices <br />445 N. Sao Joeqult, P.O. pox 2438. Stocktoo, CA 9$201-02 <br />CX 1 -1 CASH I <br />66S I <br />SEEPAGE PITS I I 0/4001 um, Number <br />juo Addm, .1.115 S , STITTEII ST. <br />SAN JOAQUIli C-OUNTT <br />ownees Homo CAPITAL _FROJEGTS Adth MU 2 Z2 f <br />. <br /> <br /> P.O. BOX 336 <br />IN commie; WODWARD DRILLG Address RIO VISTA, CA 9 /1 571 <br />TYPE OrWELIIPIIMP. NON WELL 5 s WELLREPLACEMENT n <br /> <br />PUMP INSTAI LATIEN4 5' SYSTEM REPAIR U <br />DISTANCE TO NEAREST; <br />t, WEBER AVE, 116 /8-sTocno pham 202-At 8-2 Us) <br />L icense No. 25_.$ 039 pbun7,07-374 -4300 <br />DESTRUCTION 0 Out of likcintipo'1;42 <br />OTHER CI ikinite"1* 11*21 2fij <br />SEPTIC TANK NA . SEWER LINES DISPOSAL FLD. NA , PROP. LINE 3° <br />FOUND/040N 6°1 AGRICULTURE WELL 1121_ OTHER WELL 5°7 PITS/SUMPS <br />CI lorkisbriel 0 Omo Monaco n mant•ca <br />o DormostIc/PrNate (Al Gram, Rock . El Tracy <br />il Fl Other OP 11 Deka <br />4 I ONITORING,60 SAppro.. Depl I I Eastern <br />Repair Work CloRe L3 Typo of Pomp <br />Die. of Wall Excavation IbTr -- <br />Type of Casing PVC r <br />Depth or Grout S .3eat J <br />TYPE OF WILL PROBLEM AREA CONSTRUCTION SPECiriCATiONS <br />W. DeunAttion U Will DismaNy <br />TyPE OF SEPTIC WORK; NEW INSTALLATION 11 rirPAIR,A0OtTI5N L I DESTRUCTION I ; <br />111814,Tion will COMingreiti OM*, <br />NUR**, 01 lAn uo;tr — Number of bedrooms <br />f>Srliofer Of toil o damn of 3 flat <br />BMX TANK El Typo/!,4fp Capoorty <br />PKG. TREATMENT PLT. 0 <br />DENanos to neenrst. Well <br />Saaling Material I rIlviath <br />Piller Material I Depth <br />Surface Said Insulted by CONTRA-&-Ort 4 <br />State Work Owe <br />Ms. of WO <br />SocIficattoris Scit 40 <br />Casino <br />Typo Clam iltar BEM <br />worm- tame tiotith <br />No. Chcfmtertrnants' <br />Method of Disposal <br />Foundation Property Line <br />. LEACHING ONE 0 No. & Length of lines Total length/sire <br />FILTER MD 0 niatance to riserestl VVea _ Fpunomunn Proporty Lim <br />SUMPS Dislanoe fit newest Well Foundation Property Unit <br />DISPOSAL PONDS 0 • <br />INTENDED USE: <br />INo !optic system permitrecs if perste* miaow Am <br />limitable within 203 toat.1 <br />Ow STOCKTON Lot si zetAnreags