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APPLICATION` i,FgRPERM IT
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<br /> isAR .FA0116. DADS 18hJ�
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<br /> �Y Yrr4, �f � 1� alTrlplicate). ,,•.��c�am, ,
<br /> Applicetinii i =�ter'e k aegl�3in County fob >k j�ermit to coiistriict siiid%drifnst€►il the cork riereitn desci bed. hiss
<br /> applietlttbti ifi ier L► iii ti� tiilinci tiith doiiquth C61iwfity 6rdiYsa.rtde 964 :540 aria 1W and the iiuleii and Regulations of San
<br /> Joa,YuiLl Cotityt Pti6liettt Baiwiidd9
<br /> Job Addre4e r `4 +fir l
<br /> y ,t�;itx , � { dey t~st'y �''t. '� /Lot Bize/Aci•eiige '
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<br /> Owner a N-;Ab £ "_ Addre$§' / I �l+ .yW _ 1
<br /> f L: t�Lr Phone � �
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<br /> COniracforf 1e9� �l rf ,/
<br /> Ll €ns
<br /> • Phone
<br /> TYPE OF WELL/PUMP;t,�� NEW WELL D c WELL AEPLAUMENT ❑ DESTRUCTION ❑ out of Service Weil 0
<br /> 4 Ffonitd"ring xell ❑
<br /> is ��UM
<br /> INS rALi.Y1tIDN D $Y iEM REPA1R L7 OTHEf� ❑
<br /> f DIStANC� t1 N AS = Si is 10�rA 1t"f { „ §EWER LINES DISPOSAL hb, - PROP. LINE
<br /> MUNAION 11G#iICULT'UFtE_ EL OTHER VvELLPITS/SUMPS
<br /> INTEf,It7ED.,U$ C0 UCTiON SPECIFICATIONS.
<br /> Cl Industrial =a t`�d { ,a ❑ O #h Bottom k ,; p Manteca Di
<br /> f dell Excavation Dia. a1 Well Casing
<br /> L1 6omaiitlojPii>iata! 6 b Gjave! Pic �rracy r��type d1�ari{ri�
<br /> E 1 Public + �� 'g S r' Specificaions
<br /> f a�her rmt�ti*:,�IL dB�tB pt� of Graut Seal _ 611
<br /> I I Itri sllioh;? r = i _ Type of Grout h
<br /> :Appin3s ?epic? I I EasittirA 5uiiaca 96A instaijed by
<br /> 1#epait ITls;orff 1,640 0' fyiM 61 pub R .i-
<br /> �et } I �. ' ... .;: W >�. '• ,. ,,< Statd Work Dtine_
<br /> WOW bb�truc#Ioii� � � V�+ tl b}ai"»eti F , 19Ea ing Ilste�i a bepth
<br /> oillaP Mat`erii�l�a Depth a {y'\
<br /> TYPE OF SEPTIC WORK NEW INSTALLATION I I �REPAIR/ADDI710N�1 i gE5TRUCTION! .INo se tic system
<br /> N P Y permitted if ublit Sewer is
<br /> i f 111042516 Wlthln 200 toot.I p
<br /> Instailetion riVf�It�ty�� �eaidence ���Y'��`ornrrietclal` Otket � : �.�. /�,��
<br /> Number of 1lvi�? ttnift: Number o?bedroomii ' f%
<br /> ChAracei r, %.
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<br /> SEPTIC TANS „_4 ;) '• i> �fuii m � - r Wei@r tae depth
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<br /> PKd3 tAkA64khT M. C��A",� ` r � CipaCi{y � Nn. Cbinpartment3
<br /> y� x i }:�,y F'a M9thod of Disposal
<br /> ;'Lr ih,. "r i t 4�jslariCB ftp f14�rltaf L' ,Well v ..
<br /> Etltindaiioit Pfoperty Line
<br /> LEA HIbw ,
<br /> C NG LII ,¢L �1«bd c L1�ri Ili o a
<br /> FILTEii r" " $A¢�qqi 7 i + (las , ' ti R Toiel 1enghlalze
<br /> QED� x ; '`rte
<br /> 3f rf ;. r s.. x La r^.i f c „f"O�ln� tltyh Propi►ly Linb
<br /> SEEPAt3E i�jTS I , D j�h s �r' ,i ,r a Stre s Number'.
<br /> SUMi'S f,- R a ,' CI 13itif8ri f Its aat ani 'W II
<br /> glSPOSAL Pi3NF�, �`'' y ' I� e'. oLhcfittiioh Pro` rfy Line
<br /> c- i..❑ �M'�'�,.s� f.ld r -.., - .J aiLw- c '�.� f P@
<br /> I hert3by_oaiti�y h�i I have pl p�tbtf t 13 I�I3itEa'6rt}hd ihAt ihd�Wrkrvrill b°e dbni I i§ccordance With San Joaquin county ordinhhc&s, state laws, and
<br /> ruid§end iGleiiliR b/"fHe $�n'J�bta0lit0t tlt r ,
<br /> Hnrita 6vvnAr tit lib9n3i 'Ilgafif 5 1§lieEtTil4 cfir i 'the iollai�jn6 1 berfify that its the pbsforinenca of ik'e Woik for which this;I`�armit is issued, t shall not
<br /> emp�6Y ah1iY j�$rlsoti Ih but h ttsaiinaf gat �bfi��$i bJa f t8 Workr►ibn a coKipefta iioe lav+ib of ali�OrnjB; `Coriltactot'it hiring of sub contracting signature
<br /> cartlfiia tftll follou4ih� !'� dFil�y`}hat ij ;� ( 'r iicll df thb von"rk for bvillclt thssi per li i3 MUad,l.aliail ir."i bIby pdrtiona siubject to Wotkman'si compensa-
<br /> tiara Iews o�Calift5inlg 1��:�,fryrq ,,��. , .Y�-,�� ,r ,r•�:a i� a .� ,� � ,
<br /> Th II6ti�iri4d n l �dri$`C ,t�S fWiiig do revtltae slide
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<br /> 178ti .C Area �
<br /> Pit of drdut Iniil>si Ndh
<br /> �+ r Q Ihlipectlon by
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<br /> Applicant ,a fits c6'ojpio �, �ioi9ixt County Pub7lic Meth
<br /> eviro'Aiiii tei tfeaith Permit/Servicee
<br /> ��«`i6Dl it: Ffmasiftoti Aire:;.p o Boz:�0b9 r Stdcktoa; ea'� 05201
<br /> FFF1Nf0 „�Moui�T AMIJUNt hWiTTEti~ £K
<br /> C RECEIVED By DATE PERMIT'NO.
<br /> $ll.,.r
<br /> • EH 13•24 MV,i/Ksl
<br /> EH 1/-2E
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