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pUgLIC REALTS MVICES <br /> SAN SOAQI CBANLF=AL �I'TR DIVISION l <br /> 44S Ii SAN JOAQII PHONE CZ E 95201 ti 1 V E <br /> a <br /> 468 <br /> p O <br /> SOS 2009 , STOC=C NRtv: <br /> AR <br /> PES T BYRES 1 YE <br /> CK DATE SSUED TUI 1 4 1992 <br /> Triplicate) P�4N�►�� ., i.�F'i <br /> (Complete in ,.c__ G,q <br /> t y for a per--' to canstr== sud/ar ata11 the ears ei�n" <br /> made. a Sea �O ' CSoaquln Co_ty Ordlaance Ko• 5L4 sad lSb2 sad the $,les <br /> AFp.Ucstion is heretr ,race vi.h San <br /> app]�cstiaa is made in <br /> Sos4ui.a Cauntl pubL'a Heal`.= Serrieea. ijJ t , t Loc 5ize:.c-ea8e <br /> City i <br /> 2947 Nagy Drive 888 S. gi�eroa St- a _ 4�� <br /> sob ,address � CA 9001 � Pfiana � <br /> _ Ujs An ries <br /> Santa Fe Pacific Pi line 2825 E- myrtle St- �Pnone209/465-9712 <br /> Qwner'S Name LttC:s52 No. <br /> StOC:CtOTI par= at Service We� G <br /> pectrtllil Exploration Address DESTRUCTION u <br /> Canuattor S WELL REPIACEI EM Cl OTHErR.0 Maaitrsrin8 are �. II <br /> . NEW WELL SYSTEM REPAIR ❑ <br /> firPE OF vvELLlPUMP' PROP. LINE 4,50 <br /> pljMP INSTALLATION G N A QISPOSAL FLQ N/A <br /> pIT51SUMPS >iOO <br /> N A SEWER L1NE5 OTHER'NELL��9- <br /> OISTANCe -0 NEAREST: SEPT TANK N/A AGpICULTUAE WELL <br /> i FOUNOATtoN ��� <br /> u. ln'ches ;Dia. at wed lasing02 Slog }� <br /> pp O BLI M AREA CCNSTRLlCTlOs l SPECIFICATION <br /> INTENDED USE TYPE OF WELL �� pia. of Wall Excaysttccn <br /> C Ot>eR aettarn ❑ Manteca Spetfieaaons <br /> [i Industrial Type of Casing Aa Type of Groutr �ri <br /> Q Tracy <br /> n OomesticlPrivate ❑ Gravel Pack n pelta Depth of Giout Seal t'um <br /> M Gil1erm Surface Seal installed by <br /> i'l Public th l ; Eastern <br /> Aoprax. pets - state Work Dona <br /> I k litigation H.P. <br /> � Reaair Work Done ❑ <br /> Type of Pump Bee tit 4 ±Aster-al & Dep <br /> I Weil Destruction C <br /> Wail Oiarr,eter !._fir Dyer=sl D�T•� milled N public waver :s <br /> peotn nc system per I <br /> l ayaiiable within ZO telt.) <br /> 7Y PE <br /> OF <br /> ScPTIC WORK: NEW ItvSTALLATSON I i REPAIR1AOt3lT10N f I DESTRUCTION i I l o se <br /> k ammemla, other- „. <br /> will serve: Resident° r <br /> Installationf Water table depth <br /> Number of living units: Number at bedrooms r.�•� <br /> No. C'moann+enrs I, <br /> Character of sail to a depth of 3 feet: °1 .apacitY--- - Method al Oisposat <br /> Ca TypelMfg <br /> SEPTIC TANK: <br /> PKC.TREATAAENT PLT.C1r Wed�-�- Foundation�--� Property Lin*—rte <br /> D'unnce to;ewer f <br /> Total lengtnf size <br /> [� No. b Length of Grtes Property Line. — <br /> I LEACHING LINE <br /> 4 FILTER 8ED ❑ Distance too nosiest: well Foundation <br /> �� <br /> Number <br /> 1 Sizeperty line <br /> SEEPAGE PITS I l Death wed 1.-- Foundation�� <br /> SUMPS U Distance to neeresc: <br /> DISPOSAL PONDS G Dation and [hat Cts work avid he dans in acc��dsnt:a wrrth San lttadwn cotsntY <br /> ordinaneas, state save, and <br /> that!have prepared this app tis issued. k snail not <br /> I hereby certify •I certify that in the pertonnanee at the work for which this P nature <br /> rules and regulations of the San Joaquin Cattat7 laves of California."Contractod s hiring or subcontracting sig <br /> b Home owner or licensed agent's signature oertif+e>���do�""�rttttR a cornPe�tian ns subject to workman's campensa <br /> amptaY a^Y person in such mother as to hecams c is issued,t snail amp <br /> loY Ae� <br /> 't certity tttst in the pedonTAMS of the work for which this pasrnt 3 <br /> certifies the(allowing: <br /> 'H side. �T,Ml 99 2 'c <br /> tion Iswe of Cali Carts We drawing on reverse <br /> The apviir�rtc f aired krtso+cuo^s- Project Geologist pate: <br /> Tine: <br /> f Signed ENT USE ONLY LY Area 4k3 E) <br /> I ' Data r3 y <br /> ADp1'tcation Accepted by _ -7 at �y pate <br /> pate Final Inspection by <br /> Pit or Gtout InspaQio^by <br /> AZWond C6owneow. <br /> Haviroomental Health permit=09. ct CA 98201 <br /> 1pplieaat 1- Return all sepia" to: -Sou 3oaquia County Public 92004. Sts ccs <br /> 448 b San Joaquin. P 0 Sox <br /> '# Opt:flMtT'NO- <br /> t:1t REGEty@0 sY ATS_ ^7 f <br /> * FEE A AMcu?4T(36F AMOUNT REM TTED CAS14 �� <br /> ,NFC <br /> aq,..y ` <br />