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E' I%5 r APPLICATION FOR PSllbllT eAN JOAQUIN COUNTY PUBLIC RVALTli S$RYICBS 8N IAONMENTAL USALTH DIYISIOR p o BOX 2000,. STOCETOH, CA 95201 2W 468-3447 � (Complete is Triplicate) APP11t4tioo is btraay als4e,to Ism Jasquto COLLI III Permit:o bonstruat aa4/ar 1,ASI the work berate dneribeil. Shia 11ullcoucia is&";, in coWitanca vl,h Oen Jc4g4tn C*I Oralaents No, SL4 aha 1669 AI the Aides and A1904ticns of Ueri ' Jagvla County 7utllc iI Icrillaal. r C.4 Jo'LAddrCN ��►..tf�\ C.+-1AEr'•' it 01VJT..,fi�a.. E4L111161♦I �"I�;...}F2 OwnI N" j, A U Address 7+1(tY .,..1� �tt:w<<•._ �I..li f`�7honat' rr ...i .t r 1. leonto No. C'�li•..'4_L__rhtlM t t y. _L MODE WELLIPUMP NEW WELL WILL REPLACEM[NT Ci DIBTAUL'TION CT Q:t of I9TY 9-4 e�! PUMP INSTAS."TION CI SYSTEM AEPAIR LT OTHER O KonitorliI Veli y3 DISTANCE TO NEAAIST• SEPTIC TANK t -� S[WER LINTS 5.1• DISPOSAL fL0`i't'C•PROP,LINE .2; FOUNDATIDN_;A;-.1 1 AGMCVLTUPE WILL-'T'' 4TH[A W9LL C. .r._ FITilRU3'•PF INTE-NDID USE TYPE Of WSLI PAOBLEMAA[A COKSTAUCTION SPECIFICATIONS f L7Ind4au,+�I— {J open Bollam Ll Manteca Diu.al Wes:Esctraran T Die,of WIN C613n,T VDpmtElKrP,Irale (►w�tdval P/o< i?T1acy TYY6 AT Cet n9• [=-r •rte \r� _ fipua:ueeuoni16I• 4 1. Q roar:: ' ct oln., L7 Dlita Danur o[O,ou1 re+I ••:_k I�- Type al Olo•,L�=- - _:_ �eU 362 ! •w.r..a '�...J.. i= G luya.!urn , i•Aplvoa.Depth Cl tostam ivAite!tart InsuOtf}by,Pss:.tCs',J.m�" S.>`•-�+-=j'—'-�---�"- I kePar n'ak Gtl 1 V Type of Pomp "sj N►. Su.it Wvh Dons Wel Oaalfuttloa O Wal Dumaur —fir Iasllrrs Ilsterlal t Depth 1�r.1r fa,v y -ai1':r,..f r r�;1 CsDln�� 7411.r{4Lartel ` QaPih.,� �••e4 r il.. ..A TtrE OF iEPFI6 WrMK: NEW iNSTALLATIC,t AEP�IRrA.DDITIQN DESTRUCTION INo&I evil an0dD af9..pad 11 P4boe lawaf it i ' �rawpb wunln 1tuul.l litklina:Ian wim asne: Aaaroana..... Cra4her.ie1— other NwIlbor of 4nl}unitl:_ N4nibar Oi'Adrogme_ I Chsliclar of wh to a 1'•Plh of 3 lost: --.. ,... Walst;41>10 oepin .' SEPTIC TANK Q rypelfRfy Ca"Awl•- No.Compinmontt PKG.TAEA71AENT PI.T.C1 wllinod of Diap7s91 Cltunca to nearnl: Wats Pountln:an' Propany Lino _.Y... Ic ' LSACH11,0 LINE Ll No.3 Lanyll+0f iM:; ��.— TO,at:enpin/air9 FILTER 1E0 Cl Oµlanes to haired: Wall founaauon th-4 #A SEEPAGE PITT 1I Depth --Sin stomps LI 04181 to 11611 Wa �Fovndaowl _, P,000ny Lina DISPOSAL FONpS f] _ F 1 haebr Land:that I MW Vlpa'IL'Irul IppLr.tliNi and Ihdl lha Wolk will W done in etCQId4A,I with Son Joaquin CAunt;i:rdiMMel.lisle taws,and Wll Ind I94-41oft;of th&Sim Jaastus+ County tttlme orrnef IN Ltsnasd a eni`a t halm#0m6sa the folawmp!'Y C1nAy Phil In Ilw p0orFnence of tnl rr0rh fol v&ach Inn Pnml 4 ilauad,1 anon nol lrnplar 1Ar Pelson in tuCh rnimat as to besenn tubtscl Ia woll'san's Comparsation fans of Cenlprnia.'•Gvriliaslol's li-I Dr Wa•tandlitlin6 aipnaW4 _ Cor"""the 141l11wi19:"1 tantly that iA 04 perfo.nonae 51 IM wa.k for which this p6lirlil N iss lod,f,Iistl•RSylay yNatlAe WipCI f0 wpfkman'a aorlWan lt• { °!on 11w6 01^,udortsa'f 1ha apoIII n I call ror 9A roqu fed split Camteu tu pswlnp oA 10114411609, Signed �l�( .? �+I Title: 'r.:1. y► � Vale:.�lL 1.. FOR DEPANTMINT USE ONLY p _ Application AetaQlad by Dais_. -- JJ P!I mr 01041 Ifwpstrlon by Dela p Final Inspection by ..'. Additlonal CCtltrMnle' _.,..-.-�- A9F1Esust '9tura all 401 tCI MAfl JOAIIUII! COUNTY PUBLIC isaALVII ■9111 d 1NYl ALV:II►1rSxL Sir-',I OIIIINT04 piAY17/IiR6Yl CY9 has It IAM JOAQuile, P o not >Ioalr, ISTU TOh, CA •m904 _ I fll AAtOUtiT Cut ANOIINT AIa+ITI{0 �A1 SG•er r PATS EAml1 140, c• u •Iw ply Jlr uy, 14;cx 7 •� L•w•n7 7C�111t`>L IJn)44 e IONQi: THIS �� C�� BE 4 ML' I�fN nr. TWA O �I AL