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P7-1 qS6 13:42AM FROM P. 2 <br /> APPLICATION <br /> SAIF JOAQUIN COUNTY PUBLIC HEALTH SER'VICE,S <br /> ENVINORWINTAL HEALTH DIVISION <br /> 445 N SAN JOAQUTN, PRONE (209)488-99$0 <br /> P O BOX 2009, STOCKTON, CA 95201 <br /> =118%FI]R$S� YEAR g$OX DATE Ise= - <br /> (Complete in Tziplioa.te) <br /> ARplimtiod it hereW smile to Up Jeaquis Cawety for s permit to cooatrurC atwi/or iaatail the work herein described. This <br /> witmtion is grade in aatlpliaaaa Vith sae Joaquin Cauaty 0"Ineom fid. 544 and 1W *pd the Ru;oe aid RadiilAtioas of Sea <br /> Joaquin Caaot) Plfeiie Health SHIrTicam., n ' <br /> 42 <br /> Job Addroa City-T A.,T i"c <br /> Owneie Nana it..^T Arwi7 T1TpLr Adtlraas P.A Roy 9600QI �6Cpyl y(„Apa',n;�]Pltone <br /> s <br /> gs0 ..oe ,—P sfo t 0; <br /> Cnnhacter Andra p„ ,-, finPhan <br /> TYPE OF WELUMUP: New WrYL 0 WELL REPLACEMENT' OSSTRUcnoei LT Cut of AerYips ei; ❑ <br /> �- - PUMP,INSTALLATION 0 SYSTEM REPAIR ❑ OTHEf14 NQaI ring Yell <br /> (_k>7'ANCE TO NPAAPST: SEPTIC TANK fEWCA LINES OISPOSAL PLO.,_:_.—. PROP. Lt _—p <br /> _ FOUNDATION AGRICULTURE WELL �.,_.,_._ OTHER WELL— PITS/SUMP$ <br /> JNTENOPO USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS SBL• <br /> nduatrlN D Open wham L7 Moarrteca M. of NWI ffmamhon <br /> ap. E.I RNetblPrleaN O Grew Pack 0 Tmmw Type of Coming p Speoicatnr. <br /> tI114` 191'wic Il Olho Il Rohit Depth of Grout Sea! Typo of growl <br /> Crk ' I I"ipetian ,,,,_Approa. Dmh 1 1 FAstoin Surfaws SOW In91411t4 by <br /> 1.an gopair Work Does L7 Tides M Nene H,P; State Work Daiwa <br /> Well oasbuetlon 0 Web 04rrm& Sealing Iaararial: L Depth <br /> fieadt Piller msteri." IV Aapth __- <br /> rN"rOF SEPTIC WORK: NPW tNSTAtf.ATION 1 I REPAIRIADOITION I t DESTRUCTION i l ileo septic system prmltlad if p.rblk :ewer is <br /> available within YOp gPt,1 <br /> !raealtaion.iP Gana: Re"rwe— CoMwNmew J,..._ Other <br /> ',iumbsr of swing units:_ Number of bedwins <br /> chwacNr at sad res t ompd'r of 3 feet, Witter 41 depth <br /> 5E7`1lC 'TAN9 Q Twwlmfa GW¢hv— No. Caine ion l <br /> Y/A. f1'10. TREATMENT PLT.Il mom"of OW06W <br /> Dktanes in rNararl: Will FWngptlpn Propalty tyre <br /> LEgXHIRG LINE O No.A Lomat,of mines T0141 lergrh/sfte <br /> i It TSR SEA O OkNnce to nawmst: Wall Faundalloh Property Lpls <br /> SEEPAGE ATS 1 I Depth .,,..960 Nw rltw <br /> %;v e''F'S Z1 Distance to newest: Wes Poundalipn Property Lin. <br /> 016POSAL PONDS <br /> I h4Nbt GNify thsl f INW Prepared*A appliestion amM that the wrork 40 be dory m accordance with San Joagtin camrruy,mmun ups,state jaws, and <br /> rue'_s wid AhoAfions of tills Son JoagWn Comity <br /> rte nes aw w of Eevem im"W it igWiltuN canities the fgenaena: "I parRlY Thal M time W-lormanct,of the work fa,which this parnwi is jawed, I shall nm <br /> Ar-."MY Itk*m kt sloth ortararer as to Leeuene subject to wpkrnMt`*cointle""Tion lip a Of Califernim.'"Cwrtrmctpr't hirina N authia6 Msafirrg:ipnmturm <br /> cenil a 04 faaawiag:"1 cNtily"I in the patfanrWga of fha Werk!or which this perrllit is isaued,101011 ampby pelsops Subject to v ark" a cWnppnmA. <br /> :w tiwe of CNMt)mli." <br /> The kpPlkwr7 meat o all= Ce apeala drawitla on edit. <br /> s monad u —._. risk:. �'l <br /> FOR D" E ONLY 'r - <br /> ApA,;atkln Accepted by Data _ —_ Area <br /> Ph.x Grout inspection by Data _.£final Inq+agim br Oeea <br /> AL+1i0nael Cdnantama; r, <br /> Awplit.emt - Return all copse. till Sas Josquia Causty Publio Sealth servir:es <br /> Blivisoasantal boaltim Peralt/Ifervtcem <br /> 49S a sae Joaquie, P O Ron 20M, Stka, CA pmP07 <br /> IMPO AMOUIJT ME AMOUNT REmffTED MY NO. <br /> CASN RECEIVED BY DATE ;E; <br /> Prate 132 <br /> tiPFl TT?'1-1113 t fll 97:FR 9F/:.R:�0 <br />