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AFSY AiTi QN14ba. 04* '4.-,' <br /> •`' SAKI JOAQU��IN COUNTY",P ►A�t[J°µ�Ari�.'�ry'�� <br /> 1601 E.. HAZELIN , A-VS. , PHONE (209-1468-3420. <br /> P Q BOX 200$, STOCKTON, CA8880 . '¢ "',► <br /> ,i,S' <br /> (Complete ia.`Trlpli,cate) <br /> 4*11094100 16 Aarabr m"e,to sae Jbaqutn County t"vr s Permit to construct alullor ins%su t) vont, herein dsscribedl: This <br /> application is made in cawlseace With &W doatquin County..Lrftnaoce No. 549 and 1:86$ and the Rales MW Reauutione of San <br /> Joaquin t?oU4t y11Publlc,9661th 6eryloaa, <br /> ,A . . .► f <br /> .1011 Address City + AQ - Lot SixejAcreage !" <br /> e_ f <br /> Owner's Narrle r ,, •�+ �dwe' A4dress <br /> ty,, z✓ X l lY) "�± Phone <br /> �. �► <br /> CpnlrattOr Address ` ,iCenSe_N 'Band <br /> TYPE OF WEWPUMPi NEW.YvELL © 1NEt 1.FtEi'L>i+CEMC-NT C1 ESTRLfCT7C3fi On I9e1G�ri +I .Well <br /> PUMP INSTALLATION C? ._ _ SYSTEM REPAIR CJ 1771; kat luting, blabU Cl <br /> DISTANCE TO NEAREST: SEPTIC TAt4 _ SCW�Eft LWES: -f�1S`F��SAL FI.Q _ PROPLfNir <br /> PflWNl3t4_YION AGRICVLTUR�WEj 1 .. QM H WE6i, <br /> r <br /> INTENDkO USE Tl'PE. F WfkL F IJO 3LEM BAR <br /> Ef b0 ST,iiUCT10N:SPECIACAMNS <br /> 0 Industrial Citi open bWtom O3 Mantscs � Dik o�►fVall�tivi4ttcsrr 'pia:gf Wau Gasift <br /> 0 DornesticlPrivate L"1 Gravel Pack OiTfooy Type of.Casing Specifications <br /> ["1 P1lbtic 1:1 ©tiler fl tte118 L3A11tR +if ►hLt $eaY } Type of Wdut. � <br /> t I irriUati�n Aix Depth` I !'Eastern Surfa2a 1>1i1tflCsy w,'` ..._ t <br /> gepsir Work pone () Type at Pump - H,f.., `" .. Make WtSrk �lotla� � i <br /> Well Destruclft Intel" piarneler. � ���B i�tEeXiati�k 11a1lth <br /> u Depth Fi11er Ilutet•�e -✓117+ h <br /> T PE OF URIC 1NOi11C: W INSTALLATIONi � REPA�IAt ADDtn frm "lSLs—O IO 'E I i Q seppYtc tjr;eM` 'r�i+itied if jaubiie.aawor is <br /> t' eyatlable Within 206 1"0u <br /> InstagalttoA wilt sa: encs;E , ,, Gairlmerc�i Other +< <br /> Number of kving un e <br /> ChsrattQr of soH� � � Y _ <br /> + Water thole depth <br /> SEPTIC TANK ; D Typeimf <br /> fi apac�R'_�,�__r_:�:.�., �Ib Cortsplprtrrssn <br /> PKG. TREIlTMENT Pik.0Method of Dlspos$I <br /> Dl nearest: Y*rell . Foundation Prapatay uhil <br /> t_ <br /> LEACHI Cl No. & Le z <br /> rrgth of rirses � ToteP'ielrgt <br /> 8ED Irl Distance to rearasti = Well 4 Propbrty Cifle . <br /> SEEPAGE PIT'S ! I I Depth ._...-.__.,.: ' ._.:_Size � _ � Number 1 <br /> SUMPS LI Distance to nearest: . well �`�Foundatiotl �; Prt)party Line _,�„ <br /> DISPOSAL PONES p ' <br /> !hsrtiby Certify that I haws prepared this application and that the walk will be dons In aoCW(tancs with San JOSQuin county ordinances, ttata larva, end <br /> rulas and regularipns of tela Sita Joaquin Cpuptlr <br /> Hw"awfor Or iiCensed agent's signatory cert fila the fp4owtngr '"i certif*Ihdt in the perform"CO'Of the vrark fCw which this permit k- d I shag not i <br /> anlpiny any psrwn in such manner as to t�ecornb wbjbet t0 workman's corn1511naratinn Urvif lie Cdltlati Ill, 'CcnitaClor'%hiring or 84-contracting suture <br /> Certifies fhe follow,' "i;srtdV that in the performance of the vwrork for which this permit it'iteued, I shall Mrtlploy parsons tiutljact to wptkrrtarl's Ca,ttspensa- <br /> lion taws o CaIE ," <br /> The aS:IcAni plu Calls sit requn inspe ns. Complete drawing on reverse.side.- <br /> X Title DrttO <br /> `• { �. . :... .. FOR DrEPA[fy7W1EN1r USE ONLY <br /> i Iets by Date �_"" 7 final Ittspebticn by, Date <br /> SAN JOA il•"A;Wa0aw"IMcopies toi seal Joaquin Caiutty Public Health' t�'1p #1P� �'"`f.+' (� �0-r*" <br /> e'rV.1� `q t3arvieeri, B]twSronftntal Rea4th Permit/Services _ <br /> PIJBLiC HEALTH na:; Iton Ave., P`o Bax 2W9,.st*trkrton,' CA 95201 <br /> iilYti�C�1MEifTA�. ASit R@CtIYE>i BY r <br /> EE <br /> 'INFO AMOUNT D 8 a <br /> OATS PEItmil'iVi6" <br /> . EH 11.7 <br /> EN 11.14 <br />